Use of computerized tomography by old age psychiatrists: An examination ofcriteria for investigation of cognitive impairment

Objectives. To determine the prevalence of the Royal College of Psychiatris ts' consensus criteria for the detection of potentially reversible intracra nial pathology in a group of patients over 65 years old referred for comput erized tomography (CT) head scanning from a specialist old age psychiatry s ervice, to test the association of Royal College audit criteria with the pr esence of potentially reversible intracranial pathology. Methods. A retrospective case-note survey of all patients referred from Psy chiatric Services for the Elderly at High Royds Hospital to the Neuro-imagi ng Suite at Leeds General Infirmary in the period April 1994-March 1996. Results. The records of 143 patients were examined. One or more guideline i tems were present in the notes in 97 (67.8%) subjects. Ten cases of potenti ally reversible intracranial pathology were detected and all were correctly predicted by the Royal College guidelines. All were in patients of 71 year s of age or older. The false positive rate for the guidelines was 89%. Hist ory duration of less than 1 year was the only guideline found to be associa ted with the detection of potentially reversible intracranial pathology. Conclusions. The Royal College of Psychiatrists' consensus criteria can cor rectly classify patients with potentially reversible intracranial pathology but lack the specificity to usefully reduce unnecessary CT referral or act as valid audit criteria. Copyright (C) 1999 John Wiley & Sons, Ltd.