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Computed tomography scanning and delirium in elder patients
B J Naughton1, M Moran, Y Ghaly
1Department of Medicine, University at Buffalo, NY, USA. dr2277@po2.bgh.edu
Summary
Head CT scans are inconsistently ordered for elderly patients with delirium or cognitive impairment. Acute findings on CT scans are rare, primarily linked to impaired consciousness or new focal neurologic signs in older adults.
Area of Science:
- Emergency Medicine
- Geriatric Medicine
- Radiology
Background:
- Elderly patients presenting with delirium or cognitive impairment often undergo head CT scans in emergency departments.
- Variability exists in the utilization of head CT scans for this demographic.
Purpose of the Study:
- To examine the frequency of head CT scan ordering in elderly patients with delirium and cognitive impairment.
- To identify CT scan findings associated with these neurological conditions in older adults.
Main Methods:
- A two-part study involving prospective observation and retrospective analysis of head CT scans and medical records.
- Involved over 560 adults aged 70+ across multiple emergency departments.
- Examined clinical findings in relation to acute CT scan abnormalities.
Main Results:
- Nearly 60% of elderly patients exhibited impaired cognition, consciousness, or delirium, but only 23.7% received a head CT scan.
- Delirious patients were significantly more likely to undergo head CT scans.
- 15% of CT scans revealed acute findings; 95% of these were in patients with impaired consciousness or new focal neurologic deficits.
Conclusions:
- Significant variability exists in head CT scan ordering for elderly patients with neurological findings.
- Impaired consciousness and focal neurologic signs are key indicators for acute CT findings in this population.
- Acute CT abnormalities are infrequent in elderly ED patients with other neurological findings, suggesting a need for further research before guideline development.