title: Diagnostic yield of head computed tomography for the hospitalized medical patient with delirium.
abstract: BACKGROUND
  Delirium is common in hospitalized patients and warrants early diagnosis and treatment. Often the evaluation of delirium includes head computed tomography imaging. However, in hospitalized medical patients, the yield of head computed tomography is unknown.
  
  
  OBJECTIVE
  To determine the diagnostic yield of head computed tomography when evaluating a hospitalized medical patient with delirium in the absence of a recent fall, head trauma, or new neurologic deficit.
  
  
  METHODS
  Retrospective medical record review at a large academic medical center in Boston, Massachusetts.
  
  
  METHODS
  We reviewed all medical records for head computed tomography scans performed from January 2010 through November 2012 in patients on the general medicine or medical subspecialties units.
  
  
  RESULTS
  A "positive" head computed tomography was defined as an intracranial process that could explain delirium. An "equivocal" head computed tomography was defined as the presence of a finding of unclear significance in relation to delirium.
  
  
  RESULTS
  There were 398 patients hospitalized for >24 hours who underwent head computed tomography for delirium. Two hundred twenty head computed tomography studies met eligibility criteria, with 6 (2.7%) positive and 4 (1.8%) equivocal results. All positive and equivocal findings resulted in change in management.
  
  
  CONCLUSIONS
  The diagnostic yield of head computed tomography in determining the cause of delirium in hospitalized patients is low. Due to the low rate of positive findings, head imaging is unnecessary in the majority of cases of delirium. However, there may be a subset of high-risk individuals in which head imaging is indicated.
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Division of General Medicine and Primary Care, Department of Medicine, Beth Israel, Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jesse
authors.initials: J
authors.lastname: Theisen-Toupal
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Breu
authors.forename: Melissa L P
authors.initials: ML
authors.lastname: Mattison
authors.forename: Ramy
authors.initials: R
authors.lastname: Arnaout
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D007297:Inpatients; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed