Brain Computed Tomography in Stimulant Poisoning with Altered Consciousness

Utility of computed tomography brain scans in intubated patients with overdose

OBJECTIVE

Describe the yield of computed tomography brain (CTB) scans in patients intubated for drug overdose.

METHODS

Retrospective descriptive study using existing registry data from two Australian EDs between February 2021 and June 2022.

RESULTS

Two hundred and six patients were intubated; 159 (77%) received a post-intubation CTB scan. Of these, 38 out of 159 (24%) had a documented indication (i.e. head injury and seizure) for their scans, with a yield of 5.3% (95% confidence interval [CI] = 1.5-17%). Of the 121 out of 159 (76%) patients without an indication, the yield of CTB was 0% (95% CI = 0-3%).

CONCLUSIONS

Routine imaging of patients intubated for overdose without clinical indication is unjustified.

Use of Computed Tomography of the Head in Patients With Acute Atraumatic Altered Mental Status: A Systematic Review and Meta-analysis

Importance

The usefulness of computed tomography of the head (CTH) in patients with acute-onset atraumatic altered mental status (AMS) is poorly understood, but use in these patients remains high.

Objective

To evaluate the use of CTH (event rate) in patients with AMS and the positive outcome event rate of the performed CTH studies.

Data Sources

The PubMed/MEDLINE, PubMed Central, Embase, and CINAHL databases were searched using predefined Boolean parameters. All studies that met inclusion criteria until January 31, 2022, were included.

Study Selection

Randomized clinical trials and observational, cohort, and case-control studies were included. Conference abstracts, reviews, letters, case reports, case series, systematic literature, and meta-analyses were excluded.

Data Extraction and Synthesis

The systematic literature review was performed per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were independently extracted by 2 authors. Data were pooled using a random-effects method.

Main Outcomes and Measures

Event rate of CTH use in patients with acute atraumatic AMS. The CTH event rates and positive CTH event rates were calculated with 95% CIs.

Results

Of 9338 studies identified, 26 qualified for the systematic review and 25 for the meta-analysis. The 25 studies in the meta-analysis included a total of 79 201 patients. The CTH event rate was 94% (proportion, 0.94; 95% CI, 0.76-1.00), and the positive CTH event rate was 11% (proportion, 0.11; 95% CI, 0.07-0.15). There was significant heterogeneity among the studies included (I2 > 50%, P < .001), for which a random-effects model was used. There was significant publication bias, as evident by an asymmetric funnel plot. There was no fluctuation of the results during the sensitivity analysis, which reassured the reliability of the data.

Conclusions and Relevance

In this meta-analysis, CTH use among patients with acute-onset atraumatic AMS was very high with a low yield. Large-scale studies are needed to guide clinical decision-making in such a situation.