Table. Descriptive Analysis of Studiesa.
| Source | Type of study | Place of study | Total No. of patients/No. of patients with AMS | No. of CTH events in patients with AMS | No. of positive CTH events | Setting | Outcome of CTH (defined in study) | Outcome of positive CTH findings (defined in patients with AMS) | Time to CTH | Change in management |
|---|---|---|---|---|---|---|---|---|---|---|
| Bent et al,10 2015 | Retrospective, cohort | US | 500/65 | 65 | 7 | ED | Acute/subacute stroke, ICH, mass, edema, or mass effect | NA | NA | NA |
| Callen et al,11 2020 | Retrospective, case-control | US | 9593/1816 | 1816 | 130 | ED | Hemorrhage, hydrocephalus, mass effect, or worsening of prior finding | NA | NA | NA |
| Chen et al,12 2020 | Retrospective, case-control | Taiwan | 66/66 | 31 | 0 | ED | Intracerebral hemorrhage, new ischemic infarction, or space-occupying lesions | None | 12 h | None |
| Chokshi et al,20 2016 | Retrospective, cohort | US | 2846/2846 | 2846 | 566 | ICU | Hemorrhage, infarction, mass effect, or hydrocephalus | NA | 90 min | NA |
| Covino et al,13 2019 | Observational, quasi-experimental | Italy | 1664/574 | 574 | NA (not reported for AMS) | ED | Ischemia, bleeding, or hydrocephalus | NA | NA | NA |
| Detweiler et al,27 2020 | Retrospective, case-control | US | 200/100 | 79 | NA | Mixed | White matter lesion | NA | NA | NA |
| Detweiler et al,28 2017b | Retrospective, case-control | US | 200/100 | 79 | NA | Mixed | White matter lesion, cerebral atrophy, or intracerebral calcifications | NA | NA | NA |
| Donovan et al,29 2015 | Retrospective, cohort | US | 462/ 302 | 302 | 1 | Mixed | ICH | Yes (ICH) | NA | Yes, intubated |
| Finkelmeier et al,21 2019 | Retrospective, case-control | Germany | 690/162 | 162 | 16 | ICU | ICH/SAH or stroke | NA | NA | Yes, but not clear |
| Hanna et al,30 2021 | Retrospective, cohort | US | 520/408 | 408 | 3 | Mixed | Acute ischemic stroke, hemorrhagic stroke, or SDH | NA | NA | NA |
| Hufschmidt et al,31 2008 | Retrospective, cohort | Germany | 294/294 | 178 | 25 | Mixed | Diagnostic to the acute state (no clear mention of diagnosis) | NA | NA | NA |
| Khan et al,22 2014 | Retrospective, cohort | US | 901/635 | 635 | 47 | ICU | Acute and subacute or chronic changes (infarction, hemorrhage, mass, or hydrocephalus) | NA | NA | NA |
| Lai et al,23 2010 | Retrospective, case-control | Australia | 200/25 | 25 | 6 | Inpatient | Acute ischemic stroke, hemorrhagic stroke, or SDH | NA | NA | NA |
| Lim et al,32 2009 | Retrospective, cohort | Singapore | 578/578 | 327 | 128 | Mixed | Acute infarct or ICH | NA | NA | NA |
| Nesselroth et al,14 2021 | Retrospective, cohort | Israel | 1536/116 | 116 | 23 | ED | Mass effect, herniation, ischemic stroke, or ICH | NA | NA | NA |
| Patel et al,33 2002 | Retrospective, case-control | US | 152/151 | 42 | 0 | Mixed | Acute, chronic, and none | NA | 12 h | None |
| Patel et al,15 2019 | Retrospective, cohort | India | 308/55 | 55 | 17 | ED | Infarct, ICH, or mass | Yes (SCH, 9/17) | NA | NA |
| Rahimi et al,34 2016 | Retrospective, case-control | US | 349/349 | 223 | 25 | Mixed | CVA, ICH, or mass | Yes (CVA, 13/25; ICH, 9/25) | NA | NA |
| Segard et al,16 2013 | Retrospective, case-control | France | 291/139 | 139 | 63 | ED | Stroke, TIA, tumors, and ICH | NA | NA | NA |
| Shuaib et al,18 2014 | Retrospective, cohort | US | 379/49 | 49 | 12 | ED | Mass, ischemia, ICH, or calcifications | NA | NA | NA |
| Sinclair et al,17 1993 | Retrospective, cohort | Canada | 416/25 | 25 | 8 | ED | Pathology not previously demonstrated (infarction, bleed, or SAH) | NA (not clear if outcome mentioned for AMS) | NA | Yes (surgery) |
| Thacker et al,24 2021 | Retrospective, cohort | US | 83/58 | 58 | 1 | Inpatient | SDH | Yes (SDH) | NA | Yes (surgery) |
| Theisen-Toupal et al,25 2014 | Retrospective, cohort | US | 220/220 | 220 | 6 | Inpatient | Stroke/ICH | NA | NA | Yes |
| Tu et al,5 2022 | Retrospective, cohort | US | 52 799/28 332 | 6146 | 588 | ED | Critical results (ischemic infarct, ICH, or mass lesion) | NA | NA | NA |
| Wang and You,19 2013 | Retrospective, cohort | Canada | 3967/1120 | 1120 | NA | ED | Ischemia, hemorrhage, or mass needing follow-up | NA | NA | NA |
| Wong et al,26 2014 | Retrospective, cohort | US | 187/139 | 126 | 0 | Inpatient | Ischemia, hemorrhage, or acute organic disorder | None | NA | NA |
Abbreviations: AMS, altered mental status; CTH, computed tomography of head; CVA, cerebrovascular accident; ED, emergency department; ICH, intracranial hemorrhage; ICU, intensive care unit; NA, not available; SAH, subarachnoid hemorrhage; SDH, subdural hematoma; TIA, transient ischemic attack.
a
If there was no explicit mention of contrast-enhanced CT used in the study, noncontrast CTH was assumed. If there was no explicit mention of the study setting, mixed setting (ED, inpatient unit, or ICU) was assumed. If there was no explicit mention of focal neurologic deficit in the study, it was assumed focal neurologic deficit was not associated with AMS. Therefore, the studies with AMS and focal neurologic deficit mentioned that did not allow the authors to segregate the patients with AMS were excluded.
b
Study not included in the meta-analysis because the same patient sample was used in another study by the authors.