2 days ago
Head CT May Be Essential in Older Adults With Delirium
A study found that 1 in 6 older adults with delirium in the emergency department (ED) had abnormal findings on head CT, even without traditional risk factors for intracranial pathology.
METHODOLOGY:
Researchers conducted a secondary analysis of two prospective observational studies (one conducted from 2009 to 2012 and the other from 2012 to 2014) involving a total of 160 patients with delirium, aged 65 years or older (median age, 76 years; 62.5% women; 20% non-White), at an urban, tertiary care academic hospital.
The primary outcome measure was a "positive composite head CT," defined as any acute intracranial abnormality seen during the index hospitalization or a new neurologic diagnosis within 30 days of the patient's ED visit.
Researchers evaluated the diagnostic performance of five commonly cited risk factors — including anticoagulant use, recent head trauma, focal neurologic deficits, headache, and altered level of consciousness — to determine their ability to identify patients needing head CT.
A secondary analysis was conducted to assess the diagnostic performance of six less common risk factors: Current antiplatelet use, current aspirin use, new or worsening seizures, history of brain hardware, recent falls, recent non-fall trauma, and vomiting secondary to trauma.
TAKEAWAY:
About 15.6% of older patients with delirium had a positive composite head CT.
The absence of any common risk factors did not reduce the likelihood of a positive composite head CT (negative likelihood ratio [NLR], 0.6; 95% CI, 0.2-2.4), except for focal neurologic deficits, whose absence slightly lowered this likelihood (NLR, 0.6; 95% CI, 0.4-0.9).
Only new or worsening seizures (positive likelihood ratio [PLR], 5.4; 95% CI, 0.8-36.6) and history of brain hardware (PLR, 5.4; 95% CI, 1.2-25.3) moderately increased the probability of having a positive composite head CT.
IN PRACTICE:
"Given that there is a high rate of abnormal head CTs, our study suggests that older ED patients with delirium should receive a head CT as part of the diagnostic workup, even in the absence of any risk factors," the authors wrote.
SOURCE:
The study was led by James O. Jordano, MD, Vanderbilt University Medical Center, Nashville, Tennessee. It was published online on May 16, 2025, in The American Journal of Emergency Medicine .
LIMITATIONS:
The study was limited by its single-center, secondary analysis design and small sample size. Reliance on retrospective chart review may have introduced misclassification of risk factors. Additionally, the exclusion of critically ill patients and the lack of enrollment during weekends and overnight hours may have introduced selection bias.
DISCLOSURES:
This study was funded by the National Institutes of Health, the National Center for Research Resources, and the National Center for Advancing Translational Sciences. The authors reported having no conflicts of interest.
