Likelihood and Predictors of Acute Findings on CTA Head and Neck for Neurologic Presentations to the Emergency Department

Background and Objectives: CT angiography of the head and neck (CTAHN) is commonly obtained in the emergency department (ED) for patients with acute neurologic symptoms to guide interventions. There are limited data on which clinical characteristics predict these changes. The primary objective of this study was to assess the yield of CTAHN across common neurologic ED presentations and identify patient and clinical factors associated with CTAHN findings that result in acute management change. Methods: values were reported for each independent predictor. Results: = 0.0276) were associated with CTAHN acute management change. Only univariate trends could be identified for dizziness, altered mental status, and vision changes. CTAHN was most useful in those presenting with vision loss or diplopia, but not cases of blurry vision or positive visual phenomena. Abnormalities on the preceding CT head increased the yield for altered mental status, while CTAHNs were low yield for isolated dizziness. Discussion: These results highlight specific, obtainable clinical predictors that can guide judicious use of CTAHN in the ED. Recognizing these predictors can inform emergency physicians' and neurologists' clinical judgment, optimize imaging utilization, improve resource allocation, and reduce patient burden.