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Systematic combined noncontrast CT-CT angiography in the management of unexplained nontraumatic coma
- Source :
- American Journal of Emergency Medicine, American Journal of Emergency Medicine, 2013, 31 (3), pp.494-8. ⟨10.1016/j.ajem.2012.09.024⟩, American Journal of Emergency Medicine, Elsevier, 2013, 31 (3), pp.494-8. ⟨10.1016/j.ajem.2012.09.024⟩
- Publication Year :
- 2012
-
Abstract
- International audience; BACKGROUND: Nontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis. STUDY OBJECTIVES: The aim of this prospective study was to evaluate the ability of systematic combined noncontrast computed tomography (NCCT)/computed tomography angiography (CTA) imaging, firstly to provide a neurologic prognosis and secondly to ensure early detection of basilar artery occlusion (BAO), in unexplained nontraumatic impaired consciousness management. METHODS: Combined NCCT/CTA imaging was performed on 65 patients with impaired consciousness and no history of trauma prospectively over 14 months in a single center. Images were assessed based on visual and quantitative criteria. Clinical outcome was assessed using the modified Rankin Scale at 3 months. Statistical analysis aimed to identify the prognostic value of combined NCCT/CTA imaging and its ability for early BAO detection. RESULTS: This study shows that combined NCCT/CTA imaging was a significant predictor of poor neurological outcome, with a positive predictive value of 94.6%. The combination was also crucial for early detection of BAO, given that 42.8% of cases were misdiagnosed with NCCT alone. Basilar artery occlusion represented 10.8% of all unexplained nontraumatic impaired consciousness. CONCLUSIONS: Systematic combined NCCT/CTA imaging is an efficient tool for predicting poor neurologic prognosis in cases of unexplained nontraumatic impaired consciousness and is also essential for detecting BAO.
- Subjects :
- Male
Single Center
0302 clinical medicine
MESH: Aged, 80 and over
Modified Rankin Scale
MESH: Early Diagnosis
Vertebrobasilar Insufficiency
Prospective Studies
Coma
Prospective cohort study
MESH: Multidetector Computed Tomography
Computed tomography angiography
MESH: Aged
MESH: Angiography
Aged, 80 and over
MESH: Middle Aged
medicine.diagnostic_test
Angiography
General Medicine
Middle Aged
Prognosis
MESH: Predictive Value of Tests
MESH: Young Adult
Emergency Medicine
MESH: Diagnostic Errors
[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]
Female
Radiology
medicine.symptom
Adult
medicine.medical_specialty
Adolescent
Early detection
MESH: Prognosis
MESH: Vertebrobasilar Insufficiency
03 medical and health sciences
Young Adult
Predictive Value of Tests
Multidetector Computed Tomography
medicine
Humans
[SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]
Diagnostic Errors
MESH: Coma
Aged
MESH: Adolescent
MESH: Humans
business.industry
Basilar artery occlusion
030208 emergency & critical care medicine
MESH: Adult
MESH: Male
MESH: Prospective Studies
Early Diagnosis
business
MESH: Female
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15328171 and 07356757
- Volume :
- 31
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The American journal of emergency medicine
- Accession number :
- edsair.doi.dedup.....94f7eeb042bcc91136cfd68c986af38f