High yield criteria for emergency cranial computed tomography in adult patients with no history of head injury

Objectives-A recent American study identified clinical factors which effect ively predicted those patients who would have significant findings on crani al computed tomography. It was proposed to apply these criteria in a UK set ting and to determine whether modifications could be made to improve their efficiency. Methods-A prospective observational study was conducted over a four month p eriod including all non-trauma adult patients referred from the accident an d emergency (A&E) department for urgent cranial computed tomography. Presen ting symptoms and signs were analysed for ability to predict clinically sig nificant computed tomography findings, namely: acute infarct, malignancy, a cute hydrocephalus, intracranial haemorrhage, or intracranial infection. Results-Sixty two patients were included; 22 (35%) had significant findings on computed tomography. Applying the original criteria (any of: age 60 yea rs or older, focal neurology, headache with nausea or vomiting, altered men tal status) to the study population showed that no clinically significant t omograms would have been omitted but only 11% fewer performed. Modifying th e criteria by removing "age 60 years or older" and replacing "altered menta l status" with a Glasgow coma score <14, still ensured 100% sensitivity and would have resulted in 19% fewer scans being performed, Conclusion-Simple clinical criteria can be usefully applied to patients pre senting to an A&E department in this country to target patients most likely to have clinically significant findings on urgent cranial computed tomogra phy.