Emergency department CT scan utilization and findings in geriatric patients presenting with non-traumatic headache

Abstract

Background & Objective: In geriatric patients, headache is a common reason for emergency department (ED) visits. Because secondary headaches are more common in geriatric patients than in younger patients, the former should be carefully excluded at presentation. In this study, we aimed to investigate the role of brain computed tomography (CT) in geriatric patients presenting to the ED with non-traumatic headache, the indications for imaging, the CT findings, and factors associated with detection of pathology.

Methods: Patients aged 65 years and older who presented to the ED with headache between January 1, 2023 and December 31, 2023, who underwent a brain CT scan, and who had complete data were included in the study. Patients with an intracranial mass, acute-subacute ischemic findings, intraparenchymal and subarachnoid hemorrhage, and cerebral edema on brain CT scan were considered as having significant pathology.

Results: The study included 384 patients. CT scan was normal in 61.2% of the patients and 10.4% had significant pathology. It was observed that 24.5% of the patients underwent CT scan for prolonged headache and 19.3% for severe headache. Logistic regression analysis showed that severe headache, loss of consciousness, anticoagulant use, neurological deficit, and elevated blood pressure at presentation were predictors of the detection of significant pathology on CT scan.

Conclusion: In conclusion, 10.4% of geriatric patients presenting to the emergency department with headache have significant CT findings, and the impact of these findings on the emergency management of patients cannot be ignored. Incorporating these findings into clinical decision-making guidelines could improve the effectiveness of emergency management protocols by facilitating rapid and specific diagnostic interventions for geriatric patients presenting with headache.