Analysis of emergency head computed tomography in critically ill oncological patients.
Aged
Brain Ischemia
/ diagnostic imaging
Cerebral Hemorrhage
/ diagnostic imaging
Consciousness Disorders
/ diagnostic imaging
Critical Illness
Emergencies
Female
Hematologic Neoplasms
/ complications
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Neoplasms
/ complications
Retrospective Studies
Seizures
/ diagnostic imaging
Tomography, X-Ray Computed
/ methods
altered mental status
cancer
critically ill
emergency head CT
neurological complications
Journal
Radiology and oncology
ISSN: 1581-3207
Titre abrégé: Radiol Oncol
Pays: Poland
ID NLM: 9317213
Informations de publication
Date de publication:
19 03 2021
19 03 2021
Historique:
received:
14
12
2020
accepted:
21
02
2021
pubmed:
19
3
2021
medline:
16
9
2021
entrez:
18
3
2021
Statut:
epublish
Résumé
Critically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients. This retrospective, single-centre, cohort study included patients with EHCT performed during Intensive Care Unit (ICU) admission for a period of three years. Indications, imagistic findings, type of malignancy, and outcome were evaluated to identify diagnostic yield and correlations between abnormal findings on positive scans, malignancy type, and mortality rate. Sixty-four EHCTs were performed in 54 critically ill cancer patients, with 32 scans (50%) showing previously unknown lesions and considered to be positive. The most frequent abnormal findings were ischemic (15 EHCTs, 47%) and haemorrhagic (13 EHCTs, 40%) lesions. Thirty-eight EHCTs (59%) were indicated for altered mental status, with a positivity rate of 50%. Eighteen EHCTs (48%) were performed in hematological malignancy patients: 9 (50%) of which were positive with 8/9 (89%) displaying hemorrhagic lesions. Twenty EHCTs were performed in solid tumour patients, 10 (50%) of which were positive, with 9/10 (90%) displaying ischemic lesions. Out of 54 patients, 30 (55%) died during ICU stay. The mortality rate was higher in patients with hematological malignancies and positive EHCT (78% Diagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of ICU patients. We support the systematic use of EHCT in critically ill, mainly hemato-oncological patients with nonspecific neurological dysfunction, as it may lead to early identification of intracranial complications.
Sections du résumé
BACKGROUND
Critically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients.
PATIENTS AND METHODS
This retrospective, single-centre, cohort study included patients with EHCT performed during Intensive Care Unit (ICU) admission for a period of three years. Indications, imagistic findings, type of malignancy, and outcome were evaluated to identify diagnostic yield and correlations between abnormal findings on positive scans, malignancy type, and mortality rate.
RESULTS
Sixty-four EHCTs were performed in 54 critically ill cancer patients, with 32 scans (50%) showing previously unknown lesions and considered to be positive. The most frequent abnormal findings were ischemic (15 EHCTs, 47%) and haemorrhagic (13 EHCTs, 40%) lesions. Thirty-eight EHCTs (59%) were indicated for altered mental status, with a positivity rate of 50%. Eighteen EHCTs (48%) were performed in hematological malignancy patients: 9 (50%) of which were positive with 8/9 (89%) displaying hemorrhagic lesions. Twenty EHCTs were performed in solid tumour patients, 10 (50%) of which were positive, with 9/10 (90%) displaying ischemic lesions. Out of 54 patients, 30 (55%) died during ICU stay. The mortality rate was higher in patients with hematological malignancies and positive EHCT (78%
CONCLUSIONS
Diagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of ICU patients. We support the systematic use of EHCT in critically ill, mainly hemato-oncological patients with nonspecific neurological dysfunction, as it may lead to early identification of intracranial complications.
Identifiants
pubmed: 33735950
pii: raon-2021-0014
doi: 10.2478/raon-2021-0014
pmc: PMC8042820
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
172-178Informations de copyright
© 2021 Cristian Pristavu, Adrian Martin, Anca Irina Ristescu, Emilia Patrascanu, Laura Gavril, Olguta Lungu, Madalin Manole, Daniel Rusu, Ioana Grigoras, published by Sciendo.
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