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. 2023 Jun 27;4(4):e12998.
doi: 10.1002/emp2.12998. eCollection 2023 Aug.

Head computerized tomography in emergency department evaluation of the geriatric patient with generalized weakness

Elizabeth A Calhoun  1   2 , Richard D Shih  1   2 , Patrick G Hughes  1   2 , Joshua J Solano  1   2 , Lisa M Clayton  1   2 , Scott M Alter  1   2
Affiliations

Head computerized tomography in emergency department evaluation of the geriatric patient with generalized weakness

Elizabeth A Calhoun et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: Weakness in older emergency department (ED) patients presents a broad differential. Evaluation of these patients can be challenging, and the efficacy of head computed tomography (CT) imaging is unclear. This study assesses the usefulness of head CT as a diagnostic study of acute generalized weakness in older ED patients.

Methods: This retrospective review of patients aged 65 years and older presenting to 2 community EDs included patients with a chief complaint of generalized weakness who received a head CT. Patients presenting with a focal neurologic complaint, altered mental status, or trauma were excluded. Variables evaluated included additional triage chief complaints, dementia diagnosis, and deficits on physical examination. Primary outcome was acute intracranial finding on head CT. Secondary outcomes included neurology consultation, neurosurgical consultation, and neurosurgical intervention.

Results: Of 247 patients, 3.2% had an acute intracranial abnormality on head CT. Emergent consultations for neurology and neurosurgery occurred for 1.6% and 2.4% of patients, respectively. None required neurosurgical intervention. Patients with objective weakness or focal neurologic deficits on physical examination were more likely to have acute findings on head CT (8.5% vs. 2.0%, odds ratio 4.56, confidence interval 1.10-18.95). Additional characteristics did not predict acute intracranial abnormality or need for emergent consultation.

Conclusion: Few patients with generalized weakness evaluated with head CT had acutely abnormal intracranial findings. Patients with objective weakness or neurologic deficits were more likely to have acute abnormalities. Although head CT is frequently used to evaluate geriatric weakness, its utility is low, especially in patients with normal physical examinations.

Keywords: CT head; emergency department; geriatrics; neuroimaging; weakness.

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Conflict of interest statement

The authors have no financial conflicts of interest to disclose.

References

    1. Jagoda AS, Bazarian JJ, Bruns JJ Jr, et al. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52(6):714‐748. doi: 10.1016/j.annemergmed.2008.08.021 - DOI - PubMed
    1. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Headache , Godwin SA, Cherkas DS, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2019;74(4):e41‐e74. doi: 10.1016/j.annemergmed.2019.07.009 - DOI - PubMed
    1. Pavlović T, Milošević M, Trtica S, Budinčević H. Value of head CT scan in the emergency department in patients with vertigo without focal neurological abnormalities. Open Access Maced J Med Sci. 2018;6(9):1664‐1667. Published 2018 Sep 24. doi: 10.3889/oamjms.2018.340 - DOI - PMC - PubMed
    1. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population‐based study. Stroke. 2006;37(10):2484‐2487. doi: 10.1161/01.STR.0000240329.48263.0d - DOI - PMC - PubMed
    1. Covino M, Gilardi E, Manno A, et al. A new clinical score for cranial CT in ED non‐trauma patients: Definition and first validation. Am J Emerg Med. 2019;37(7):1279‐1284. doi: 10.1016/j.ajem.2018.09.032 - DOI - PubMed

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