title: Head computed tomography in the emergency department: a collection of easily missed findings that are life-threatening or life-changing.
abstract: BACKGROUND
  The use of noncontrast head computed tomography (CT) has become commonplace in the emergency department (ED) as a means of screening for a wide variety of pathologies. Approximately 1 in 14 ED patients receives a head CT scan, and analyzing and interpreting this high volume of images in a timely manner is a daily challenge.
  
  
  OBJECTIVE
  Minimizing interpretation error is of paramount importance in the context of life-threatening and time-sensitive diagnoses. Therefore, it is prudent for the physician to recognize particular pitfalls in head CT interpretation and establish search patterns and practices that minimize such errors. In this article, we discuss a collection of common ED cases with easily missed findings, and identify time-effective practices and patterns to minimize interpretation error.
  
  
  CONCLUSIONS
  There are numerous reasons for false-negative interpretations, including, but not limited to, incomplete or misleading clinical history, failure to review prior studies, suboptimal windowing and leveling, and failure to utilize multiple anatomic views via multi-planar reconstructions and scout views. We illustrate this in four specific clinical scenarios: stroke, trauma, headache, and altered mental status.
  
  
  CONCLUSIONS
  Accurate and timely interpretation in the emergent setting is a daily challenge for emergency physicians. Knowledge of easily overlooked yet critical findings is a first step in minimizing interpretation error.
authors.affiliation: University of California, San Diego School of Medicine, San Diego, California.
authors.forename: Camille
authors.initials: C
authors.lastname: Malatt
authors.affiliation: University of California, San Diego School of Medicine, San Diego, California.
authors.forename: Mazen
authors.initials: M
authors.lastname: Zawaideh
authors.affiliation: Department of Radiology, UC San Diego Health System, San Diego, California.
authors.forename: Cherng
authors.initials: C
authors.lastname: Chao
authors.affiliation: Department of Radiology, UC San Diego Health System, San Diego, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Hesselink
authors.affiliation: Department of Radiology, UC San Diego Health System, San Diego, California; Department of Radiology, San Diego VA Medical Center, San Diego, California.
authors.forename: Roland R
authors.initials: RR
authors.lastname: Lee
authors.affiliation: Department of Radiology, UC San Diego Health System, San Diego, California; Department of Radiology, San Diego VA Medical Center, San Diego, California.
authors.forename: James Y
authors.initials: JY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000000981:diagnostic imaging*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000000981:diagnostic imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: altered mental status; head CT; headache; stroke; trauma