title: Utility of CT head in the acute setting: value of contrast and non-contrast studies.
abstract: BACKGROUND
  To examine the added diagnostic value of emergent contrast enhanced CT head (CECTH) in patients who present to the emergency department (ED) with acute non-traumatic symptoms referable to the brain, and to assess the financial implications of CECTH in the emergent setting.
  
  
  METHODS
  We queried healthcare data for head CTs ordered by our ED between January 2008 and December 2010. Those who presented to the ED with non-traumatic neurologic disturbances were included. All traumatic head injury cases were excluded. Two board certified radiologists with fellowship training who were blinded to patient history and physical findings, independently reviewed all non-contrast computed tomography of the head (NCTH) and CECTH images. CECTH's were read following abnormal NCTH's, and findings were recorded as normal or abnormal.
  
  
  RESULTS
  In our investigation, 379 patients-210 (55 %) females and 169 (45 %) males-met the inclusion criteria. Common indications for head CT included: headache 183 (48 %); dizziness 73 (19 %); altered mental status 49 (13 %); and seizure 38 (10 %). The mean age of study subjects was 47 (±29) years. Two hundred sixty-one (69 %) of all patients scanned showed no abnormality. One hundred eighteen (31 %) of 379 patients had abnormal scans. We encountered 1 abnormal CECTH on which NCTH was normal. Cost of CECTH was $465 and NCTH was $385.
  
  
  CONCLUSIONS
  Head CT in ED non-traumatic neurological presentations with CECTH is not generally indicated and represents a calculable cost savings in the management of these patients.
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308, USA, waqas.shuaib@emory.edu.
authors.forename: W
authors.initials: W
authors.lastname: Shuaib
authors.forename: M H
authors.initials: MH
authors.lastname: Tiwana
authors.forename: F H
authors.initials: FH
authors.lastname: Chokshi
authors.forename: J O
authors.initials: JO
authors.lastname: Johnson
authors.forename: H
authors.initials: H
authors.lastname: Bedi
authors.forename: F
authors.initials: F
authors.lastname: Khosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage*; D004636:Emergency Service, Hospital; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006261:Headache / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D012640:Seizures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media