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Abstract Details
Low yield of head CT in cirrhotic patients presenting with hepatic encephalopathy
BMJ Open Gastroenterol. 2021 Jun;8(1):e000609. doi: 10.1136/bmjgast-2021-000609.
Angy Hanna1, Inayat Gill2, Zaid Imam3, Alexandra Halalau45, Laith H Jamil35
Author information
1Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA angy.hanna@beaumont.org.
2Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
3Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, Michigan, USA.
4Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
5Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
Abstract
Goals and background: The utility of routine head CT (HCT) in hepatic encephalopathy (HE) evaluation is unclear. We investigated HCT yield in detecting acute intracranial abnormalities in cirrhotic patients presenting with HE.
Study: Retrospective review of cirrhotic patient encounters with HE between 2016 and 2018 at Beaumont Health, in Michigan was performed. A low-risk (LR) indication for HCT was defined as altered mental status (AMS), which included dizziness and generalised weakness. A high-risk (HR) indication was defined as trauma/fall, syncope, focal neurological deficits (FNDs) or headache. Descriptive statistics and univariate/multivariate analyses by logistic regression were performed using SPSS to identify HCT abnormality correlates.
Results: Five hundred twenty unique encounters were reviewed. Mean age was 63.4 (12.1) years, 162 (37.5%) had alcoholic cirrhosis and median Model for End-Stage Liver Disease (MELD)-score was 17 (13-23). LR indication was reported in 408 (78.5%) patients and FNDs reported in 24 (4.6%) patients. Only 13 (2.5%) patients were found to have an acute intracranial pathology (seven haemorrhagic stroke, two ischaemic stroke, four subdural haematoma). Aspirin use prior to presentation (aOR 4.6, 95% CI 1.1 to 19.2), and HR indication (aOR 7.3, 95% CI 2.3 to 23.8) were independent correlates of acute intracranial pathology on HCT. Age, sex, MELD-score, haemoglobin, platelet count, race and cirrhosis aetiology did not correlate with HCT abnormalities. Number needed to screen to identify one acute pathology was 14 in HR indications versus 82 for LR indications.
Conclusion: Routine HCTs in cirrhotic patients presenting with HE with AMS in the absence of history of trauma, headache, syncope, FNDs or aspirin use is of low diagnostic yield.