AEM systematic review provides new insights into head imaging abnormalities in patients with acute delirium

Older adults who come to the Emergency Department (ED) with altered mental status (AMS), delirium, or confusion are more likely to have an acutely abnormal finding on computed tomography (CT) if they have a focal neurological deficit. This is one conclusion of Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review published in the June issue of Academic Emergency Medicine (AEM) journal, the peer-reviewed journal of the Society for Academic Emergency Medicine (SAEM).

Objectives of the systematic review and meta-analysis were to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging, and to assess whether anticoagulation, neurological deficits, trauma, or headache were associated with head imaging abnormalities in these patients.

The lead authors of this article are Shan W. Liu, MD, SD, associate professor of emergency medicine at Harvard Medical School and Sangil Lee, clinical associate professor of emergency medicine at University of Iowa Carver College of Medicine. With this study, Liu et. al found that 16% of head CTs ordered in the ED on older adults presenting with delirium, AMS, or confusion had an acutely abnormal finding. Anticoagulation was not associated with an abnormal head CT and findings of a focal neurologic deficit greatly increased the odds of an abnormal head CT. The authors were unable to comment on the association of headache or trauma with an abnormal head CT.

This systematic review was conducted on behalf of the Geriatric Emergency Department Delirium Guidelines Group. It lays the groundwork for determining a recommendation for geriatric ED guidelines regarding brain imaging for all delirious older adults in the ED.