Clinical predictors of significant findings on head computed tomographic angiography.
BACKGROUND
Although head computed tomographic angiography (CTA) is a sensitive tool for the evaluation of neurological symptoms in the emergency department (ED), little is known about which clinical signs predict significant CTA findings.


OBJECTIVE
To identify clinical factors that predict significant findings on head CTA in patients presenting to the ED with neurological complaints.


METHODS
Retrospective chart review of consecutive adult patients undergoing head CTA over a 6-month period in an urban, tertiary care ED with an annual volume of 76,000. Significant head CTA findings were defined as clinically significant neurological abnormalities undetected by previous imaging studies. Demographics, chief complaint, results of the neurological examinations (NE), and head non-contrast computed tomography (CT) results were used as predictors of significant head CTA. All predictors with a univariate p < 0.2 using Pearson's chi-squared were entered stepwise into a multivariable logistic regression including odds ratios (OR), with inclusion restricted to p < 0.05.


RESULTS
Chart review yielded 456 cases; 215 (47%) were male. Mean age was 62 (SD 20) years. There were 189 patients (41%) with abnormal CTAs. Multivariable logistic regression indicated five variables that predicted a clinically significant CTA: abnormal CT (OR 3.72), chief complaint of subarachnoid hemorrhage-type headache (OR 2.30), and motor deficit (OR 2.23), visual deficit (OR 2.23), and other focal deficit (OR 2.18) on NE. A chief complaint of trauma (OR 0.23) predicted a normal CTA.


CONCLUSIONS
Specific historical and focal neurological findings are useful for predicting clinically significant findings on head CTA.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Soheil
S
Jamshidi
Prem A
PA
Kandiah
Aneesh B
AB
Singhal
Joshua B
JB
Resnick
Karen L
KL
Furie
Pierre
P
Borczuk
Blair A
BA
Parry
Michael
M
Lev
Walter J
WJ
Koroshetz
Yuchiao
Y
Chang
John T
JT
Nagurney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001927:Brain Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014786:Vision Disorders / Q000209:etiology