title: Brain computer tomography in critically ill patients--a prospective cohort study.
abstract: BACKGROUND
  Brain computer tomography (brain CT) is an important imaging tool in patients with intracranial disorders. In ICU patients, a brain CT implies an intrahospital transport which has inherent risks. The proceeds and consequences of a brain CT in a critically ill patient should outweigh these risks. The aim of this study was to critically evaluate the diagnostic and therapeutic yield of brain CT in ICU patients.
  
  
  METHODS
  In a prospective observational study data were collected during one year on the reasons to request a brain CT, expected abnormalities, abnormalities found by the radiologist and consequences for treatment. An "expected abnormality" was any finding that had been predicted by the physician requesting the brain CT. A brain CT was "diagnostically positive", if the abnormality found was new or if an already known abnormality was increased. It was "diagnostically negative" if an already known abnormality was unchanged or if an expected abnormality was not found. The treatment consequences of the brain CT, were registered as "treatment as planned", "treatment changed, not as planned", "treatment unchanged".
  
  
  RESULTS
  Data of 225 brain CT in 175 patients were analyzed. In 115 (51%) brain CT the abnormalities found were new or increased known abnormalities. 115 (51%) brain CT were found to be diagnostically positive. In the medical group 29 (39%) of brain CT were positive, in the surgical group 86 (57%), p 0.01. After a positive brain CT, in which the expected abnormalities were found, treatment was changed as planned in 33%, and in 19% treatment was changed otherwise than planned.
  
  
  CONCLUSIONS
  The results of this study show that the diagnostic and therapeutic yield of brain CT in critically ill patients is moderate. The development of guidelines regarding the decision rules for performing a brain CT in ICU patients is needed.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, PObox 22660, 1100, Amsterdam, DD, The Netherlands.
authors.forename: Ilse M
authors.initials: IM
authors.lastname: Purmer
authors.forename: Erik P
authors.initials: EP
authors.lastname: van Iperen
authors.forename: Ludo F M
authors.initials: LF
authors.lastname: Beenen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kuiper
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Peter W
authors.initials: PW
authors.lastname: Vandertop
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome