Journal article
Absence of risk factors cannot exclude abnormal imaging findings in older delirious emergency department patients
The American journal of emergency medicine, Vol.95, pp.49-52
09/2025
DOI: 10.1016/j.ajem.2025.05.023
PMID: 40403368
Abstract
Head computed tomography (CT) is routinely performed in older delirious emergency department (ED) patients, but little evidence-based guidance exists as to when it should be obtained. We sought to determine if the absence of risk factors was sufficient to not obtain a head CT in this population.
This was a secondary analysis of two prospective observational studies. Delirious ED patients ≥ 65 years old were included. We evaluated risk factors most associated with abnormal head imaging, including anticoagulant use, recent head trauma, focal neurological deficits, headache, or altered level of consciousness. Our primary outcome was "Positive composite head CT"-an acute pathological finding on the index hospitalization head CT OR, if a patient did not receive a head CT, as an acute pathological finding on imaging or new neurological diagnosis within 30 days post-ED visit. Sensitivities, specificities, and likelihood ratios (LR) with 95 % confidence intervals were calculated.
A total of 160 patients were included. The median (IQR) age was 76 (69, 83) years old. There were 25 (15.6 %) older delirious patients with a positive composite head CT. Having any risk factor was 92.0 % (81.4-100.0 %) sensitive and 13.3 % (7.6-19.1 %) specific for a positive CT, with a negative LR of 0.6 (0.3-2.43) and positive LR of 1.1 (0.9-1.2).
In older ED delirious patients, the proportion of positive CTs was high. The absence of any risk factor minimally decreased the likelihood of having a positive head CT. Our data suggests that head CTs should be considered in all older ED patients with delirium.
Details
- Title: Subtitle
- Absence of risk factors cannot exclude abnormal imaging findings in older delirious emergency department patients
- Creators
- James O Jordano - Vanderbilt University Medical CenterSangil Lee - University of IowaJin H Han - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.95, pp.49-52
- DOI
- 10.1016/j.ajem.2025.05.023
- PMID
- 40403368
- NLM abbreviation
- Am J Emerg Med
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Publisher
- Elsevier
- Grant note
- National Institutes of Health: K23AG032355 National Center for Research Resources: UL1 RR024975-01, 2 UL1 TR000445-06
JHH and this study was funded by the National Institutes of Health under award number K23AG032355. This study was also supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06.
- Language
- English
- Electronic publication date
- 05/16/2025
- Date published
- 09/2025
- Academic Unit
- Emergency Medicine; Injury Prevention Research Center
- Record Identifier
- 9984824301802771
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