Use of computerized tomography by old age psychiatrists: an examination of criteria for investigation of cognitive impairment.
OBJECTIVE
To determine the prevalence of the Royal College of Psychiatrists' consensus criteria for the detection of potentially reversible intracranial pathology in a group of patients over 65 years old referred for computerized tomography (CT) head scanning from a specialist old age psychiatry service, to test the association of Royal College audit criteria with the presence of potentially reversible intracranial pathology.


METHODS
A retrospective case-note survey of all patients referred from Psychiatric Services for the Elderly at High Royds Hospital to the Neuro-imaging Suite at Leeds General Infirmary in the period April 1994-March 1996.


RESULTS
The records of 143 patients were examined. One or more guideline items were present in the notes in 97 (67.8%) subjects. Ten cases of potentially reversible intracranial pathology were detected and all were correctly predicted by the Royal College guidelines. All were in patients of 71 years of age or older. The false positive rate for the guidelines was 89%. History duration of less than 1 year was the only guideline found to be associated with the detection of potentially reversible intracranial pathology.


CONCLUSIONS
The Royal College of Psychiatrists' consensus criteria can correctly classify patients with potentially reversible intracranial pathology but lack the specificity to usefully reduce unnecessary CT referral or act as valid audit criteria.
Branton
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Psychiatry of Old Age, Psychiatric Services for the Elderly, High Royds Hospital, Ilkley, UK.
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003072:Cognition Disorders / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D005852:Geriatric Psychiatry / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D006113:United Kingdom