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

Aurore Esquevin 1 Hélène Raoult 1 Jean-Christophe Ferré 1 Thomas Ronzière 2 Aymeric Stamm 3 Mathieu Perennes 4 Abdelouahab Bellou 4 Jean-Yves Gauvrit 1, 3
3 VisAGeS - Vision, Action et Gestion d'informations en Santé
INSERM - Institut National de la Santé et de la Recherche Médicale : U746, Inria Rennes – Bretagne Atlantique , IRISA-D5 - SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE
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.
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Submitted on : Tuesday, July 16, 2013 - 5:15:51 PM
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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, Elsevier, 2013, 31 (3), pp.494-8. ⟨10.1016/j.ajem.2012.09.024⟩. ⟨inserm-00845285⟩



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