Back to Search Start Over

ACR Appropriateness Criteria® Acute Mental Status Change, Delirium, and New Onset Psychosis

Authors :
Michael D. Luttrull
Daniel J. Boulter
Claudia F.E. Kirsch
Joseph M. Aulino
Joshua S. Broder
Santanu Chakraborty
Asim F. Choudhri
Andrew F. Ducruet
A. Tuba Kendi
Ryan K. Lee
David S. Liebeskind
William Mack
Toshio Moritani
Robert P. Roca
Lubdha M. Shah
Aseem Sharma
Robert Y. Shih
Sophia C. Symko
Julie Bykowski
Source :
Journal of the American College of Radiology. 16:S26-S37
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Acute changes in mental status represent a broad collection of symptoms used to describe disorders in mentation and level of arousal, including the more narrowly defined diagnoses of delirium and psychosis. A wide range of precipitating factors may be responsible for symptom onset including infection, intoxication, and metabolic disorders. Neurologic causes that may be detected on neuroimaging include stroke, traumatic brain injury, nonconvulsive seizure, central nervous system infection, tumors, hydrocephalus, and inflammatory disorders. Not infrequently, two or more precipitating factors may be found. Neuroimaging with CT or MRI is usually appropriate if the clinical suspicion for an acute neurological cause is high, where the cause of symptoms is not found on initial assessment, and for patients whose symptoms do not respond appropriately to management. There was disagreement regarding the appropriateness of neuroimaging in cases where a suspected, nonneurologic cause is found on initial assessment. Neuroimaging with CT is usually appropriate for patients presenting with delirium, although the yield may be low in the absence of trauma or a focal neurological deficit. Neuroimaging with CT or MRI may be appropriate in the evaluation of new onset psychosis, although the yield may be low in the absence of a neurologic deficit. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Details

ISSN :
15461440
Volume :
16
Database :
OpenAIRE
Journal :
Journal of the American College of Radiology
Accession number :
edsair.doi...........2100f15360e06eb56d0ad77363e75608
Full Text :
https://doi.org/10.1016/j.jacr.2019.02.024