Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar;71(3):946-958.
doi: 10.1111/jgs.18134. Epub 2022 Nov 26.

Diagnostic yield of CT head in delirium and altered mental status-A systematic review and meta-analysis

Haris Akhtar  1 , Shazia H Chaudhry  2 , Émilie Bortolussi-Courval  3 , Ryan Hanula  3 , Anas Akhtar  4 , Bénédicte Nauche  5 , Emily G McDonald  1   3   6
Affiliations
Review

Diagnostic yield of CT head in delirium and altered mental status-A systematic review and meta-analysis

Haris Akhtar et al. J Am Geriatr Soc. 2023 Mar.

Abstract

Background: CT head is commonly performed in the setting of delirium and altered mental status (AMS), with variable yield. We aimed to evaluate the yield of CT head in hospitalized patients with delirium and/or AMS across a variety of clinical settings and identify factors associated with abnormal imaging.

Methods: We included studies in adult hospitalized patients, admitted to the emergency department (ED) and inpatient medical unit (grouped together) or the intensive care unit (ICU). Patients had a diagnosis of delirium/AMS and underwent a CT head that was classified as abnormal or not. We searched Medline, Embase and other databases (informed by PRISMA guidelines) from inception until November 11, 2021. Studies that were exclusively performed in patients with trauma or a fall were excluded. A meta-analysis of proportions was performed; the pooled proportion of abnormal CTs was estimated using a random effects model. Heterogeneity was determined via the I2 statistic. Factors associated with an abnormal CT head were summarized qualitatively.

Results: Forty-six studies were included for analysis. The overall yield of CT head in the inpatient/ED was 13% (95% CI: 10.2%-15.9%) and in ICU was 17.4% (95% CI: 10%-26.3%), with considerable heterogeneity (I2 96% and 98% respectively). Heterogeneity was partly explained after accounting for study region, publication year, and representativeness of the target population. Yield of CT head diminished after year 2000 (19.8% vs. 11.1%) and varied widely depending on geographical region (8.4%-25.9%). The presence of focal neurological deficits was a consistent factor that increased yield.

Conclusion: Use of CT head to diagnose the etiology of delirium and AMS varied widely and yield has declined. Guidelines and clinical decision support tools could increase the appropriate use of CT head in the diagnostic etiology of delirium/AMS.

Keywords: CT head; altered mental status; delirium; high value medical care; overdiagnosis.

PubMed Disclaimer

Similar articles

See all similar articles

References

REFERENCES

    1. Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994;97(3):278-288. doi:10.1016/0002-9343(94)90011-6
    1. Francis J, Young B. Diagnosis of delirium and confusional states. 2021.
    1. Gibb K, Seeley A, Quinn T, et al. The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study. Age Ageing. 2020;49(3):352-360. doi:10.1093/ageing/afaa040
    1. Fong TG, Inouye SK, Jones RN. Delirium, dementia, and decline. JAMA Psychiat. 2017;74(3):212. doi:10.1001/jamapsychiatry.2016.3812
    1. Wongpakaran N, Wongpakaran T, Bookamana P, et al. Diagnosing delirium in elderly Thai patients: Utilization of the CAM algorithm. BMC Fam Pract. 2011;12(1). doi:10.1186/1471-2296-12-65