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Inappropriate Usage and Very Low Diagnostic Yield of CT Head in Patients With Recurrent Seizure FREE TO VIEW

Vijay Vanam, MD; Viswanath Vasudevan, MD; Praveen Jinnur, MD; Qammar Abbas, MD; Sarah Lee, MD; Farhad Arjomand, MD
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Brooklyn Hospital Center, Brooklyn, NY

Chest. 2013;144(4_MeetingAbstracts):358A. doi:10.1378/chest.1703357
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: American Academy of Neurology (AAN) recommends emergent CT of brain in all patients who present with a new onset seizure. AAN also recommends a repeat CT brain in patients with recurrent seizures who present with new focal deficits, persistent altered mental status (with or without intoxication), fever, recent trauma, persistent headache, history of cancer, history of anti-coagulation, or suspicion of AIDS, New seizure pattern or new seizure type or prolonged postictal confusion or worsening mental status. The objectives of this study 1)Diagnostic yield of repeat CT head. 2) Compliance of providers with AAN guidelines

METHODS: Retrospective chart review of all the patients >18 years who were admitted with seizures and received emergent CT head from January 2012 to December 2012

RESULTS: There were 306 patients; 180 males and 126 females. Mean age of 45. 207 patients met AAN guidelines for emergent CT scan for seizures. In 99 (32.35 %) patients, repeat CT head was deemed as inappropriate. 44 % had break through seizures and needed additional / change in medications,41 % had withdrawal seizures due to non-compliance , 7 % were ETOH related seizures, 3 % had sub therapeutic levels, 2% had Mass lesions ( 1 benign tumor & 1 intra cranial bleed), 2% had Benzodiazepine abuse with h/o seizure disorder and 1 % had metabolic abnormality.

CONCLUSIONS: Only in 2 % of 99 patients who didn't meet AAN criteria had abnormal CT findings. Compliance to AAN guidelines was noted to be very poor.

CLINICAL IMPLICATIONS: Repeat CT scan has a very low yield in following clinical contexts: 1) new toxic/ metabolic disorders 2) sub therapeutic level of anti epileptic medications. 3) alcohol related either withdrawal or intoxication.4) idiopathic epilepsy. Provider education and reinforcement of compliance with AAN guidelines will help prevent inappropriate use of CT scan.

DISCLOSURE: The following authors have nothing to disclose: Vijay Vanam, Viswanath Vasudevan, Praveen Jinnur, Qammar Abbas, Sarah Lee, Farhad Arjomand

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