title: Journal Club: Head CT scans in the emergency department for syncope and dizziness.
abstract: OBJECTIVE
  The purpose of this study was to determine the yield of acutely abnormal findings on head CT scans in patients presenting to the emergency department with dizziness, near-syncope, or syncope and to determine the clinical factors that potentially predicted acutely abnormal head CT findings and hospital admission.
  
  
  METHODS
  We retrospectively reviewed the electronic medical records of all patients presenting to an HMO emergency department between July 1, 2012, and December 31, 2012, who underwent head CT for a primary complaint of dizziness, syncope, or near-syncope. The primary outcomes were head CT scans with acutely abnormal findings and hospital admission. Binary logistic regression was used to assess the association between clinical variables and acute head CT findings and between clinical variables and hospital admission.
  
  
  RESULTS
  Of the 253 patients who presented with dizziness, 7.1% had head CT scans with acutely abnormal findings, and 18.6% were admitted. Of the 236 patients who presented with syncope or near-syncope, 6.4% had head CT scans with acutely abnormal findings, and 39.8% were admitted. The following three clinical factors were found to be significantly correlated with acutely abnormal head CT findings: a focal neurologic deficit (p = 0.003), age greater than 60 years (p = 0.011), and acute head trauma (p = 0.026).
  
  
  CONCLUSIONS
  Our results suggest that most patients presenting with syncope or dizziness to the emergency department may not benefit from head CT unless they are older, have a focal neurologic deficit, or have a history of recent head trauma.
authors.affiliation: 1 John A. Burns School of Medicine, University of Hawaii, Honolulu, HI.
authors.forename: Myles M
authors.initials: MM
authors.lastname: Mitsunaga
authors.forename: Hyo-Chun
authors.initials: HC
authors.lastname: Yoon
mesh_terms: D017677:Age Distribution; D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D004244:Dizziness / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D013575:Syncope / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
keywords: CT; dizziness; emergency department; syncope; vertigo