In Reply: Computed tomography of the head

Gilad Muth; Thomas A. Bayer; Richard Libman

doi:10.3949/ccjm.90c.08002

We thank Dr. Ganatra for his comments regarding our 1-Minute Consult.¹ In particular, he has brought to our attention recent research concerning the use and utility of computed tomography (CT) in delirium and altered mental status.² His suggestion to individualize the differential diagnosis and use pretest probabilities to stratify risk is valid, and we fully agree with it. A crucial distinction, however, is that the study cited by Dr. Ganatra included both hospitalized patients and patients in the emergency department, whereas the study we cited and our patient case included only hospitalized patients. The diagnostic yield in emergency department patients may not be generalizable to already-hospitalized patients because these settings have different acuity levels. In fact, head imaging in the emergency department reveals an intracranial process in 14% to 39% of cases, which appears to differ significantly from the yield of CT in hospitalized patients.³

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