Cunqueiro Alain, Durango Alejandra, Fein Daniel M, Ye Kenny, Scheinfeld Meir H
Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210th St., Bronx, NY, 10467, USA.
Department of Psychiatry, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY, USA.
Pediatr Radiol. 2019 Feb;49(2):240-244. doi: 10.1007/s00247-018-4265-y. Epub 2018 Oct 5.
Children presenting to the emergency department with acute psychosis or hallucinations sometimes undergo a head CT to evaluate for a causative lesion. The diagnostic yield of head CT in this scenario has not been reported.
To determine the yield for head CT in children with acute psychosis or hallucinations.
We retrospectively searched the radiology report database over a 7.5-year period for head CT reports for pediatric emergency department patients using the following keywords: hallucination, psychosis, psychotic or "hearing voices." All reports were categorized as normal or abnormal, and we reviewed and categorized the abnormal cases. We calculated the 95% confidence interval for abnormal CTs using the method of Clopper and Pearson.
We identified 397 pediatric emergency department head CTs. We excluded one non-diagnostic exam. We excluded 34 additional cases (which were all normal) because of clinical indications that might have independently triggered a head CT. Of the remaining 362 cases, 12 reports described abnormalities or variants and we reviewed them individually. Based on consensus review, four were normal, four had congenital malformations, three had encephalomalacia versus demyelination and one demonstrated cortical atrophy. There were no cases with actionable findings such as mass, hemorrhage, infection or hydrocephalus. The 95% confidence interval for a CT demonstrating causative findings was calculated at 0-0.82%.
In the absence of concerning factors such as focal neurological deficits, evidence of central nervous system infection, trauma or headache, routine screening head CT might not be warranted in children presenting with acute psychosis or hallucinations.
因急性精神病或幻觉到急诊科就诊的儿童有时会接受头部CT检查，以评估是否存在致病病变。这种情况下头部CT的诊断率尚未见报道。
确定急性精神病或幻觉患儿头部CT的诊断率。
我们回顾性检索了7.5年期间放射学报告数据库，以查找儿科急诊科患者的头部CT报告，使用了以下关键词：幻觉、精神病、精神错乱或“幻听”。所有报告分为正常或异常，我们对异常病例进行了审查和分类。我们使用克洛珀-皮尔逊方法计算了异常CT的95%置信区间。
我们识别出397例儿科急诊科头部CT检查。我们排除了一项未得出诊断结果的检查。由于可能独立引发头部CT检查的临床指征，我们又排除了另外34例（均为正常）病例。在其余362例病例中，12份报告描述了异常或变异情况，我们对其进行了逐一审查。根据共识审查，4例为正常，4例有先天性畸形，3例有脑软化与脱髓鞘改变，1例有皮质萎缩。没有出现如肿块、出血、感染或脑积水等可采取行动的发现。显示致病发现的CT的95%置信区间计算为0-0.82%。
在没有如局灶性神经功能缺损、中枢神经系统感染、创伤或头痛等相关因素的情况下，对于因急性精神病或幻觉就诊的儿童，可能无需进行常规筛查头部CT。
