Role of contrast enhanced cranial CT scan on the management of patients with clinical diagnosis of stroke

Abstract

Objectives : To identify the therapeutic impact of contrast enhanced computed tomography (CECT) that the treatment plan made by clinicians are altered as a result of application of CECT in patient with clinical diagnosis of stroke. Design : Observational prospective descriptive study Setting : King Chulalongkorn Memorial Hospital Participants : Two hundreds and fifty seven adult patients, age more than 45 years old with clinical diagnosis of stroke who need CT scan for treatment plan were enrolled in this study. Methods : CT scans were performed with informed consent and interpreted by radiology residents. The treatments were planned by clinicians after CT result. Additional CECT were performed only in cases that clinicians request with various reasons. Outcome measures : Main outcome was proportion of cases which required CECT that change treatment plan from stroke to others and cost effectiveness analysis was evaluated. Results : In 257 cases of the patients with clinical diagnosis of stroke who need CT for treatment planning additional CECT were requested in 52 cases (20.2%). Only 5 cases that treatment plan were changed from ischemic stroke and hypertensive bleeding. By using cost effectiveness analysis the cost effectiveness ratio is about 29,000 Baht. By using sensitivity analysis, the cost effectiveness ratio of CECT will increase up to 31,500 Baht if nonionic contrast media is used instead of ionic contrast media. Conclusion : Only nonenhanced CT scan should be enough for treatment plan in neurologic condition of stroke in aging (more than 45 years old) if normal CT scan, typical patterns of ischemic stroke or hypertensive bleeding are demonstrated. However, experience in using criterial of clinical diagnosis and experience in CT interpretation are needed.