Shin Somi, Lee Hui Jai, Shin Jongwhan, Lee Sejong
Department Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
Clin Exp Emerg Med. 2018 Mar 30;5(1):1-6. doi: 10.15441/ceem.16.163. eCollection 2018 Mar.
Brain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings.
Patients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of <15 were included in the study.
Among the 367 brain CT results of patients with AMS during the study period, 146 (39.8%) were positive. In a multivariate analysis, the presence of focal neurologic deficit (odds ratio [OR], 132.6; 95% confidence interval [CI], 37.8 to 464.6), C-reactive protein level <2 mg/dL (OR, 3.9; 95% CI, 1.4 to 10.6), and Glasgow Comal Scale score <9 (OR, 2.4; 95% CI, 1.2 to 4.8) were significantly associated with positive brain CT results.
The presence of focal neurologic deficit, initial Glasgow Comal Scale score of <9, and initial C-reactive protein levels of <2 mg/dL can facilitate the selection of brain CT to diagnose patients with acute AMS in the emergency department.
脑部计算机断层扫描（CT）常用于诊断急性意识障碍（AMS），这是许多严重疾病中极为重要的症状。然而，CT结果为阴性的情况很常见，这导致了CT的不必要使用。因此，本研究旨在确定与CT阳性结果相关的临床因素。
对从基于急诊科登记处选取的急性AMS患者进行回顾性评估。纳入研究的患者为初次就诊时患有非创伤性和非传染性疾病且格拉斯哥昏迷量表评分<15分者。
在研究期间，367例AMS患者的脑部CT结果中，146例（39.8%）为阳性。多因素分析显示，存在局灶性神经功能缺损（比值比[OR]，132.6；95%置信区间[CI]，37.8至464.6）、C反应蛋白水平<2mg/dL（OR，3.9；95%CI，1.4至10.6）以及格拉斯哥昏迷量表评分<9分（OR，2.4；95%CI，1.2至4.8）与脑部CT阳性结果显著相关。
存在局灶性神经功能缺损、初始格拉斯哥昏迷量表评分<9分以及初始C反应蛋白水平<2mg/dL有助于在急诊科选择脑部CT来诊断急性AMS患者。
