Analysis of Emergency Head Computed Tomography in Critically Ill Oncological Patients

Emergency Head CT in Onco-ICU Patients

Abstract

Introduction

Critically ill cancer patients have an increased risk of developing acute neurological dysfunction. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients.

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, radiology reports, type of malignancy and outcome were evaluated to identify diagnostic yield and correlation between the abnormal findings on positive scans, malignancy type and mortality rate.

Results

64 EHCTs were performed in 54 critically ill cancer patients, 32 scans (50%) showing previously unknown lesions and counted as positive. The most frequent abnormal findings were ischemic (15EHCTs, 47%) and hemorrhagic (13EHCTs, 40%) lesions 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 them were positive, 8/9 (89%) with hemorrhagic lesions. Twenty EHCTs were performed in solid tumor patients, 10 (50%) were positive, 9/10 (90%) had ischemic lesions. Out of 54 patients, 30 (55%) died during ICU. The mortality rate was significantly higher in patients with hematological malignancies and positive versus negative EHCT (7/9, 78% respectively 7/12, 58%).

Conclusion

Diagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of critically ill patients. The systematic use of EHCT in critically ill hemato-oncological patients with nonspecific neurological dysfunction may lead to early identification of intracranial complications.