Mind the guideline gap: emergent CT in patients with epilepsy for trauma rule-out-A retrospective cohort study.

Q2 Medicine
Kristina Szabo, Udo Obertacke, Vesile Sandikci, Sarah Ghanayem, Angelika Alonso, Johann S Rink, Annika Marzina, Michael Platten, Carolin Hoyer
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引用次数: 0

Abstract

Background: Patients with epileptic seizures represent a significant proportion of emergency department (ED) admissions and are often referred for cranial imaging due to suspected or observed trauma. Neurological guidelines provide limited advice on indications for imaging in this scenario, and traumatological clinical decision rules on the use of CT in mild traumatic brain injury explicitly exclude patients with seizures preceding the trauma. This gap in recommendations may contribute to overimaging for trauma rule-out after a seizure.

Methods: We analysed medical records of patients with known epilepsy admitted to our ED after a seizure between January 2022 and March 2024. Using clinical data including the findings from cranial CT and risk factors for traumatic brain injury, we re-assessed the need for CT imaging by application of the Canadian CT head rule (CCHR) or in the context of head trauma under anticoagulation.

Results: During the observational period, 683 patients with known epilepsy were referred to our hospital due to a seizure (mean age 48.8 years, 57.7% male). A head CT scan was obtained in 337 (49.3%) of all encounters. In only two patients, CT diagnosed an acute seizure-related traumatic lesion, one focal subarachnoid haemorrhage and one skull base fracture. Twenty-six cases (3.8%) with seizure-related trauma were reassessed as requiring a CT for trauma-related injury evaluation. Particularly in the absence of head impact or risk factors, a high degree of variability regarding CT ordering practice was observed.

Conclusions: Our results demonstrate frequent use and low diagnostic yield of CT in ED seizure patients with respect to trauma-related head injury. Circumstantial factors, clinical signs or symptoms and medical risk factors variedly impact on clinicians' decision to perform imaging. The absence of clear recommendations regarding imaging for trauma apparently provokes frequent diagnostic rule-out even in patients with low risk for traumatic brain injury. We suggest an approach to identify patients not requiring a head CT by considering the CCHR, presence of anticoagulation and appreciating the postictal state as a feature specific to patients with seizures.

注意指南差距:癫痫患者急诊CT对创伤的排除——一项回顾性队列研究。
背景:癫痫发作患者在急诊科(ED)入院患者中占很大比例,由于怀疑或观察到的创伤,他们经常被转介进行颅脑影像学检查。神经学指南对这种情况下的成像适应症提供了有限的建议,创伤学临床决策规则在轻度创伤性脑损伤中使用CT明确排除了创伤前癫痫发作的患者。这种建议上的差距可能会导致癫痫发作后对创伤排除的过度成像。方法:我们分析了2022年1月至2024年3月期间癫痫发作后入住急诊科的已知癫痫患者的医疗记录。根据临床数据,包括颅脑CT的发现和创伤性脑损伤的危险因素,我们通过应用加拿大CT头部规则(CCHR)或在抗凝治疗的头部创伤的背景下重新评估CT成像的必要性。结果:观察期内因癫痫发作转诊的已知癫痫患者683例,平均年龄48.8岁,男性57.7%。337例(49.3%)患者接受了头部CT扫描。只有两名患者的CT诊断为急性癫痫相关的外伤性病变,一名局灶性蛛网膜下腔出血和一名颅底骨折。26例(3.8%)癫痫相关创伤患者被重新评估为需要CT进行创伤相关损伤评估。特别是在没有头部撞击或危险因素的情况下,观察到CT排序的高度可变性。结论:我们的研究结果表明,CT在ED癫痫患者中对外伤性头部损伤的诊断率较低。环境因素、临床体征或症状和医疗风险因素对临床医生进行影像学检查的决定有不同的影响。缺乏关于创伤成像的明确建议显然会导致即使是低风险的创伤性脑损伤患者也经常被排除在诊断之外。我们建议采用一种方法,通过考虑CCHR、抗凝剂的存在以及将癫痫患者的后状态作为特定特征来识别不需要头部CT的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
7.40
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0.00%
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14 weeks
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