Head CT may be overused in emergency departments

Few patients who present to the emergency department with syncope or dizziness actually need a head CT scan, even though current medical practice pressures physicians to perform them, according to a new study in the American Journal of Roentgenology.

Fewer than 7.1% of patients coming to the emergency department with dizziness and 6.4% complaining of syncope or near-syncope benefited from the use of head CT, concluded researchers from Kaiser Foundation Hospital in Honolulu.

"If a careful history and physical examination do not find persistent neurologic signs, then a follow-up clinic visit the next day may be all that is necessary," said principal investigator Dr. Myles Mitsunaga in a statement.

The retrospective study looked at the electronic medical records of patients who presented to an HMO emergency department during the second half of 2012 and underwent a head CT for a primary complaint of dizziness, syncope, or near-syncope. The researchers looked for head CT scans with acutely abnormal findings and rates of hospital admission (AJR, January 2015, Vol. 204:1, pp. 24-28).

Of the 253 patients presenting with dizziness, 7.1% had head CT scans with acutely abnormal findings, and 18.6% were admitted to the hospital. Of the 236 patients who presented with syncope or near-syncope, 6.4% had head CT scans with acutely abnormal findings, and 39.8% were admitted.

Three clinical factors were found to correlate significantly with acutely abnormal head CT: having a focal neurologic deficit (p = 0.003), being older than 60 years (p = 0.011), and experiencing acute head trauma (p = 0.026), the authors wrote.

Unless the patients are older, have a focal neurologic deficit, or have a recent history of head trauma, CT is probably unnecessary, the study team concluded.