Prevalence of abnormal cranial CT scan in Nontraumatic headache patients with red flag symptoms at the emergency department in Hospital Universiti Sains Malaysia

• Published in: Medical journal of Malaysia Vol. 77; no. 4; pp. 427 - 432
• Main Authors: MNoor, F A, Mafauzy, M M, Sjahid, A S, Yaacob, N, Baharuddin, K A
• Format: Journal Article
• Language: English
• Published: 01-07-2022
• ISSN: 0300-5283

INTRODUCTIONData on the prevalence of nontraumatic headaches with red flag symptoms in Asia are sparse. Therefore, the objectives of this study were to determine the final diagnosis and prevalence of abnormal CT scans in patients who presented to the emergency department (ED) with red flag symptoms. MATERIALS AND METHODSThis was a retrospective study based on the Radiology Department database of patients who presented to the ED with complaints of nontraumatic headache, had red flag symptoms, and underwent cranial CT scans. The inclusion criteria were adult patients presenting through the ED with nontraumatic headache who underwent cranial CT scans. Multivariate analysis was performed based on logistic regression to analyse the significance of the predictive value for abnormal CT scans. RESULTSA total of 216 patients underwent cranial CT scans in the ED. More than half of the cases (53.7%) were male. A total of 146 patients (67.6%) had no obvious abnormalities in the CT scans, while 41 patients (19.0%) had cranial infarction, 9 patients (4.2%) had intracranial bleeding, and 20 patients (9.3%) had brain tumours. The most common diagnosis was primary headache syndrome, followed by cerebral vascular accident (CVA). Multivariate analysis showed that three factors were associated with abnormal CT scans: age, systolic blood pressure (SBP), and mean arterial pressure (MAP). New onset of headache at the age of 50 years or older (Odds Ration, OR 3.21, 95% Confidence Interval, CI 1.15, 8.94), SBP (OR 4.82. 95%CI 2.29, 10.40) and MAP (OR 6.21, 95%CI 2.71, 14.70) were significant. CONCLUSIONThe prevalence of abnormal CT scan findings in nontraumatic headache patients with red flag symptoms was 32%. Primary headache syndrome is the most common diagnosis. An age greater than 50 years old during the onset of headache, SBP greater than 180mmHg and MAP greater than 120mmHg were associated with a higher risk of abnormal cranial CT scans.