Brain computer tomography in critically ill patients - a prospective cohort study
Open Access
- 12 December 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Medical Imaging
- Vol. 12 (1), 34
- https://doi.org/10.1186/1471-2342-12-34
Abstract
Brain computer tomography (brain CT) is an important imaging tool in patients with intracranial disorders. In ICU patients, a brain CT implies an intrahospital transport which has inherent risks. The proceeds and consequences of a brain CT in a critically ill patient should outweigh these risks. The aim of this study was to critically evaluate the diagnostic and therapeutic yield of brain CT in ICU patients. In a prospective observational study data were collected during one year on the reasons to request a brain CT, expected abnormalities, abnormalities found by the radiologist and consequences for treatment. An “expected abnormality” was any finding that had been predicted by the physician requesting the brain CT. A brain CT was “diagnostically positive”, if the abnormality found was new or if an already known abnormality was increased. It was “diagnostically negative” if an already known abnormality was unchanged or if an expected abnormality was not found. The treatment consequences of the brain CT, were registered as “treatment as planned”, “treatment changed, not as planned”, “treatment unchanged”. Data of 225 brain CT in 175 patients were analyzed. In 115 (51%) brain CT the abnormalities found were new or increased known abnormalities. 115 (51%) brain CT were found to be diagnostically positive. In the medical group 29 (39%) of brain CT were positive, in the surgical group 86 (57%), p 0.01. After a positive brain CT, in which the expected abnormalities were found, treatment was changed as planned in 33%, and in 19% treatment was changed otherwise than planned. The results of this study show that the diagnostic and therapeutic yield of brain CT in critically ill patients is moderate. The development of guidelines regarding the decision rules for performing a brain CT in ICU patients is needed.Keywords
This publication has 15 references indexed in Scilit:
- Recommendations for the intra-hospital transport of critically ill patientsCritical Care, 2010
- The Role of Head Computer Tomographic Scans on the Management of MICU Patients With Neurological DysfunctionJournal of Intensive Care Medicine, 2009
- Head CT is of limited diagnostic value in critically ill patients who remain unresponsive after discontinuation of sedationBMC Anesthesiology, 2009
- Necessity of Repeat Head CT and ICU Monitoring in Patients With Minimal Brain InjuryThe Journal of Trauma and Acute Care Surgery, 2009
- Incidence of complications in intrahospital transport of critically ill patients – experience in an Austrian university hospitalWiener klinische Wochenschrift, 2007
- Utility of Repeat Head Computed Tomography After Blunt Head Trauma: A Systematic ReviewThe Journal of Trauma and Acute Care Surgery, 2006
- Routinely Repeated Computed Tomography after Blunt Head Trauma: Does it Benefit Patients?The Journal of Trauma and Acute Care Surgery, 2004
- Changes in cerebral glycolytic activity during transport of critically ill neurotrauma patients measured with microdialysisZeitschrift für Neurologie, 2002
- Head computed tomography in medical intensive care unit patients: Clinical indicationsCritical Care Medicine, 2000
- Equipment review: Intrahospital transport of critically ill patientsCritical Care, 1999