Cranial CT scans--emergency department utilization

The purpose of this retrospective review was to determine high-yield criteria for the ordering of cranial computed tomography (CT scans) in the emergency department. All patients (n = 416) presenting to an adult tertiary care Emergency Department over a 1-year period who required an emergency CT scan were studied. The indications for the scan and the rate of abnormal results were headache (26%), seizures (17%), focal weakness (46%), acute trauma (37%), late trauma (22%), altered mental status (32%), coma (54%), and other (32%). The overall rate of abnormal scans was 39%. In conclusion, the current clinical practice of ordering cranial CT scans on an emergency basis seems to produce an acceptable level of "abnormal" results. Additional prospective studies are required to further define high-yield criteria and measure the impact of the "negative" scan on patient management.