Journal article
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review
Academic emergency medicine, Vol.30(6), pp.616-625
06/2023
DOI: 10.1111/acem.14622
PMID: 36330667
Abstract
BACKGROUND Delirium, altered mental status or confusion among older adults are common presentations to the emergency department (ED). We aimed to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging. We also assessed whether anticoagulation, neurological deficits, trauma or headache were associated with head imaging abnormalities in these patients. METHODS A systematic review was performed using Ovid Medline, Embase, Clinicaltrials.gov, Web of Science, and Cochrane Central from conception to April 8th , 2021. Citations were included if they described patients aged 65 years or older who received neuroimaging at the time of ED assessment for delirium, confusion, or altered mental status. Screening, data extraction, and bias assessment were performed in duplicate. The estimated proportion of patients with abnormal neuroimaging and odds ratios for each predictor were calculated. RESULTS The search strategy identified 3,014 unique citations, of which six studies reporting on 909 patients with confusion or altered mental status were included. None of the studies formally diagnosed delirium. Overall, the proportion of older ED patients with altered mental status or confusion were found to have an abnormal head CT was 15.6% (95% CI 7.3-26.2%). The prevalence of focal neurologic findings was 0.13 and for anticoagulation was 0.09 among the studies who reported them. The presence of a focal neurological deficit was associated with abnormal head CT (odds ratio [OR] 101.8; 95% CI 30.5-340.1). Anticoagulation was not associated with abnormal head CT (OR 1.2; 95% CI 0.4-3.3). No studies reported on the association between headache or trauma and abnormal neuroimaging. CONCLUSION The proportion of abnormal findings on CT neuroimaging in older ED patients with altered mental status or confusion was 15.6%. The presence of a focal neurological deficit was a strong predictor for the presence of acute abnormality, whereas anticoagulation was not.
Details
- Title: Subtitle
- Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review
- Creators
- Shan W Liu - Massachusetts General HospitalSangil Lee - Roy J. and Lucille A. Carver College of MedicineJane M Hayes - Washington University in St. LouisDanya Khoujah - Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.Alexander X Lo - Northwestern UniversityMichelle Doering - Washington University in St. LouisKerstin de Wit - Queen's UniversityChristian H NickelsMaura KennedyDebra EaglesChristopher CarpenterGlenn ArendtsLuna RagsdaleGeriatric Emergency Department Delirium Guidelines Group
- Resource Type
- Journal article
- Publication Details
- Academic emergency medicine, Vol.30(6), pp.616-625
- DOI
- 10.1111/acem.14622
- PMID
- 36330667
- NLM abbreviation
- Acad Emerg Med
- ISSN
- 1069-6563
- eISSN
- 1553-2712
- Grant note
- DOI: 10.13039/100007619, name: Society for Academic Emergency Medicine, award: AGEM Executive Board
- Language
- English
- Electronic publication date
- 11/04/2022
- Date published
- 06/2023
- Academic Unit
- Emergency Medicine; Injury Prevention Research Center
- Record Identifier
- 9984314260202771
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