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The Role of Head Computer Tomographic Scans on the Management of MICU Patients With Neurological Dysfunction

Division of Pulmonary and Critical Care Medicine, Christiana Health Care System, Newark, Delaware, dsalerno{at}christianacare.org

Paul E. Marik, MD, FCCM, FCCP

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Constantine Daskalakis, ScD

Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania

Paul Kolm, PhD

Division of Biostatistics, Christiana Health Care System, Newark, Delaware

Frank Leone, MD, MS

Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Neurological dysfunction is common in patients admitted to the medical intensive care unit (MICU). However, the indications for head imaging in those patients are unclear. The objective of this study was to assess whether clinical variables would be useful in selecting patients who are likely to have an abnormality on head computerized tomographic (CT) scanning and to determine the impact of such scans on management decisions. We reviewed the charts of 740 patients admitted to our MICU between October 2002 and July 2004. A total of 123 patients (16.6%) had a head CT scan performed, with a new finding being present in 26 (21.1%) patients. In the patients with a new CT finding, there was a change in diagnosis in 11 (42%) patients and a change in treatment in 6 (23%) patients. Logistic regression analysis failed to determine any clinical characteristic that could predict a new finding on the CT scan. This study suggests that clinicians should have a low threshold for ordering a CT scan in MICU patients with acute neurological dysfunction.

Key Words: head computer tomography • ICU • critical care • neurological signs • diagnosis • management

This version was published on November 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 6, 372-375 (2009)
DOI: 10.1177/0885066609344940


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