Characteristics and outcome of acute stroke patients not investigated with computerised tomography scan.
BACKGROUND
It is desirable that all acute stroke patients are investigated with a computerised tomography (CT) scan, but there may be situations when this is not possible.


OBJECTIVE
To investigate the characteristics and outcome of acute stroke patients not investigated with a CT scan and whether 'not performing a CT scan' influences mortality.


METHODS
Consecutive acute stroke patients admitted to a general hospital were studied for baseline characteristics, previous stroke, pre-stroke Rankin score, post-stroke neurological details, functional disability, complications and acute phase and 3-month mortality. Patients were categorised into two groups depending on whether or not they were investigated with a CT scan. chi(2) and regression analysis were performed to study characteristics and mortality.


RESULTS
Ninety-four of the 296 patients did not undergo investigation with a CT scan. These patients were older (p = 0.001), had suffered previous strokes and had a poorer general health prior to admission (p < 0.001). Although there was no difference in clinical stroke syndromes and immediate post-stroke functional impairment, they had a greater impairment of level of consciousness (p = 0.003) and had a higher acute phase and 3-month mortality (p = 0.001). Not being investigated with a CT scan had an adverse influence on 3-month mortality independent of other variables.


CONCLUSIONS
Whilst not investigating with a CT scan in acute stroke patients carries a poor prognosis, a group of patients may be managed without this investigation because of their poor pre-existing general health. These facts may be considered when preparing local guidelines for brain imaging for acute stroke patients.
Sharma
Jagdish
J
King's Mill Hospital, Sutton in Ashfield, UK. jsharma@lineone.net
Fletcher
Sally
S
Vassallo
Michael
M
Butcher
Clive
C
Ross
Ian
I
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome