Diagnostic Yield and Influence on Length of Stay of Brain Computed Tomography for Elderly Patients With Altered Mental Status in an Emergency Setting

NCT04929704 | Unknown

• 1 other identifier: DISCUSS-CT
• Study Type: observational
• Target: 470
• Locations: 1 country
• Sites: 1

Brief Summary

The confusional syndrome is defined by the acute or subacute onset of a deficit syndrome (temporo-spatial disorientation, memory and concentration disorders, abnormal behavior, impairment of intellectual efficiency, fluctuation of disorders with an increase in the evening) that may be associated with a productive syndrome (visual or auditory hallucinations, delusional elements) (French College of Neurology). It is a frequent, serious and costly problem in hospitalized patients and in emergency rooms. Its prevalence is between 10 and 31% of cases in emergency rooms and concerns up to one out of two elderly patients during a hospitalization. The potential morbidity and mortality of the confusional syndrome is due in part to the difficulty of identifying and treating rapidly the triggering and aggravating factors that are often interrelated in the elderly. Most often, these are drug effects, metabolic disorders, infections, consequences of prolonged immobilization or physical restraint. The lack of rapid treatment of these causes increases the risk of medium and long-term cognitive problems. Because of the aging population, this is an increasingly expensive problem. In 2012, the World Health Organization Regional Office for Europe study conducted in 18 European countries combined estimated its cost at $182 billion per year. The management of confusional syndrome in the elderly is now a major public health issue. It is a targeted indicator of the safety and quality of care for the elderly.

Conditions

Altered Mental Status

Keywords

elderly patients

Outcome Measures

Primary Outcomes (1)

• Determine the diagnostic yield of brain scans without contrast injection for patients aged ≥ 75 years with isolated confusional syndrome (proportion of scans explaining symptomatology)

  Evidence of a recent intracranial abnormality compatible with the patient's symptomatology (isolated confusional syndrome)

  Day 1

Secondary Outcomes (4)

• To determine the impact of performing an injection-free brain scan to patients aged ≥ 75 years with isolated confusional syndrome on the duration of their emergency department management.

  Day 1

• Identify the anamnestic, clinical, and biological variables available in the emergency department associated with the discovery of an intracranial process on CT explaining the clinical picture.

  Day 1

• To determine the main etiology of the confusional syndrome in patients whose CT scan did not find an acute abnormality explaining the symptomatology.

  Day 1

• Determine the impact of the CT scan result on the patient's initial medical management strategy (first 24 hours).

  Day 1

Eligibility Criteria

• Age: 75 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patient aged ⩾ 75 years who had a brain scan without contrast injection in the emergency department due to isolated confusional syndrome between January 1, 2019 and December 31, 2019.

You may qualify if:

• Patient aged ⩾ 75 years who had a brain scan without contrast injection in the emergency department due to isolated confusional syndrome between January 1, 2019 and December 31, 2019.
• French-speaking patient

You may not qualify if:

• Patient with concomitant localizing neurological signs of confusional syndrome: abnormalities of the cranial pairs, unusual headaches, meningeal syndrome, cerebellar syndrome, systematized sensory or motor deficit, vestibular syndrome, Glasgow Coma Scale score ≤ 8.
• Patient who has had a head injury and is taking a long-term antiplatelet and/or anticoagulant therapy.
• Patient objecting to the use of their data for this research.
• Patient deprived of liberty
• Patient under court protection

Sponsors & Collaborators

• Fondation Hôpital Saint-Joseph: lead

Study Sites (1)

Groupe Hospitalier Paris Saint Joseph

Paris, Île-de-France Region, 75014, France

Location

Study Officials

• Camille GERLIER, MD

  Fondation Hôpital Saint-Joseph

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 10, 2021
• First Posted: June 18, 2021
• Study Start: June 11, 2021
• Primary Completion: July 11, 2021
• Study Completion: May 31, 2023
• Last Updated: June 30, 2022

Record last verified: 2022-04

Locations

FR (1)