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Journal Articles American Journal of Emergency Medicine Year : 2013

Systematic combined noncontrast CT-CT angiography in the management of unexplained nontraumatic coma

Abstract

BACKGROUND: Nontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis. STUDY OBJECTIVES: The aim of this prospective study was to evaluate the ability of systematic combined noncontrast computed tomography (NCCT)/computed tomography angiography (CTA) imaging, firstly to provide a neurologic prognosis and secondly to ensure early detection of basilar artery occlusion (BAO), in unexplained nontraumatic impaired consciousness management. METHODS: Combined NCCT/CTA imaging was performed on 65 patients with impaired consciousness and no history of trauma prospectively over 14 months in a single center. Images were assessed based on visual and quantitative criteria. Clinical outcome was assessed using the modified Rankin Scale at 3 months. Statistical analysis aimed to identify the prognostic value of combined NCCT/CTA imaging and its ability for early BAO detection. RESULTS: This study shows that combined NCCT/CTA imaging was a significant predictor of poor neurological outcome, with a positive predictive value of 94.6%. The combination was also crucial for early detection of BAO, given that 42.8% of cases were misdiagnosed with NCCT alone. Basilar artery occlusion represented 10.8% of all unexplained nontraumatic impaired consciousness. CONCLUSIONS: Systematic combined NCCT/CTA imaging is an efficient tool for predicting poor neurologic prognosis in cases of unexplained nontraumatic impaired consciousness and is also essential for detecting BAO.

Dates and versions

inserm-00845285 , version 1 (16-07-2013)

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Aurore Esquevin, Hélène Raoult, Jean-Christophe Ferré, Thomas Ronzière, Aymeric Stamm, et al.. Systematic combined noncontrast CT-CT angiography in the management of unexplained nontraumatic coma. American Journal of Emergency Medicine, 2013, 31 (3), pp.494-8. ⟨10.1016/j.ajem.2012.09.024⟩. ⟨inserm-00845285⟩
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