{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:57:03Z","timestamp":1792112223212,"version":"4.4.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007619","name":"Society for Academic Emergency Medicine","doi-asserted-by":"publisher","award":["AGEM Executive Board"],"award-info":[{"award-number":["AGEM Executive Board"]}],"id":[{"id":"10.13039\/100007619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Delirium, altered mental status (AMS), or confusion among older adults are common presentations to the emergency department (ED). We aimed to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging. We also assessed whether anticoagulation, neurological deficits, trauma, or headache were associated with head imaging abnormalities in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was performed using Ovid Medline, Embase, Clinicaltrials.gov, Web of Science, and Cochrane Central from conception to April 8, 2021. Citations were included if they described patients aged 65\u2009years or older who received neuroimaging at the time of ED assessment for delirium, confusion, or AMS. Screening, data extraction, and bias assessment were performed in duplicate. The estimated proportion of patients with abnormal neuroimaging and odds ratios (ORs) for each predictor were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The search strategy identified 3014 unique citations, of which six studies reporting on 909 patients with confusion or AMS were included. None of the studies formally diagnosed delirium. Overall, the proportions of older ED patients with AMS or confusion were found to have an abnormal head computed tomography (CT) was 15.6% (95% confidence interval [CI] 7.3%\u201326.2%). The prevalence of focal neurologic findings was 13.0% (66\/506) and for anticoagulation was 9.8% (33\/337) among the studies who reported them. The presence of a focal neurological deficit was associated with abnormal head CT (OR 101.8, 95% CI 30.5\u2013340.1). Anticoagulation was not associated with abnormal head CT (OR 1.2, 95% CI 0.4\u20133.3). No studies reported on the association between headache or trauma and abnormal neuroimaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The proportion of abnormal findings on CT neuroimaging in older ED patients with AMS or confusion was 15.6%. The presence of a focal neurological deficit was a strong predictor for the presence of acute abnormality, whereas anticoagulation was not.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14622","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T07:24:57Z","timestamp":1667546697000},"page":"616-625","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Head computed tomography findings in geriatric emergency department patients with delirium, altered mental status, and confusion: A systematic review"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-3717","authenticated-orcid":false,"given":"Shan W.","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangil","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8745-6240","authenticated-orcid":false,"given":"Jane M.","family":"Hayes","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danya","family":"Khoujah","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1869-2776","authenticated-orcid":false,"given":"Alexander X.","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Doering","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2763-6474","authenticated-orcid":false,"given":"Kerstin","family":"de Wit","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Queen's University  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Geriatric Emergency Department Delirium Guidelines Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12436"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12706"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12692"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14166"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.4"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.03.002"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c3704"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-017-0465-5"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.1018"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2012.07.003"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9343(98)00292-7"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.13.1406"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.24"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2006.00806.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-020-01846-6"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11547-018-0871-x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.1997.tb03690.x"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2008.01118.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.07.023"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000100"},{"key":"e_1_2_10_22_1","unstructured":"Tool to Assess Risk of Bias in Longitudinal Symptom Research Studies Aimed at the General Population. CLARITY Group at McMaster University. DistillerSR. Accessed February 13 2022.https:\/\/www.evidencepartners.com\/resources\/methodological\u2010resources\/tool\u2010to\u2010assess\u2010risk\u2010of\u2010bias\u2010longitudinal\u2010symptom\u2010research\u2010studies\u2010aimed\u2010at\u2010the\u2010general\u2010population\u2010distillersr"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0236763"},{"key":"e_1_2_10_24_1","first-page":"S113","article-title":"Is brain CT scanning appropriate in evaluating mental status change in the elderly? [abstract]","volume":"61","author":"Das M","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afy203.02"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2020.11.025"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.15441\/ceem.16.163"},{"issue":"6","key":"e_1_2_10_28_1","first-page":"447","article-title":"Improving emergency Department Care for Aging Missourians: guidelines, accreditation, and collaboration","volume":"114","author":"Carpenter CR","year":"2017","journal-title":"Mo Med"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066617720901"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2198"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40138-021-00226-9"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.158454"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12120732"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.09.032"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.05.044"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/453978"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-015-1305-x"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-6757(95)90080-2"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14622","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acem.14622","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14622","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T09:14:11Z","timestamp":1692436451000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.14622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,5]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1111\/acem.14622"],"URL":"https:\/\/doi.org\/10.1111\/acem.14622","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,5]]},"assertion":[{"value":"2022-04-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}