A clinical decision instrument for head CT in intoxicated patients presenting to the emergency department: the DITCH study

Figures & data

Figure 1. Intoxicated patients screened for head CT.

Figure 2. Agents involved in intoxicated cases.

Other includes patients with ingestants that were either non-psychotropic, or few in number (<1%):

• Non-opioid analgesics (acetaminophen, aspirin and NSAIDs)

• Anti-diabetic medications

• Chemicals and gases

Recreational substances (Caffeine, LSD)

Table 1. Non contrast head CT findings in intoxicated patients.

Non-contrast head CT finding	Number of patients (%)
Normal	279 (68)
Chronic	82 (20)
Incidental	15 (4)
Acute	31 (8)
subarachnoid haemorrhage	7
subdural haemorrhage	9
parenchymal bleed	3
fractured skull	2
oedema / hypoxic ischaemic encephalopathy	2
scalp haematoma	7
nose fracture	6
Subtotal acute	36 findings in 31 patients
Total patients	407

Table 2. Frequencies of acute head CT findings and the accuracy of five DITCH clinical features.

Key DITCH Clinical Feature	Intoxicated patients with CT acute finding who had this feature, N (%)	Intoxicated patients without acute CT finding who had this feature, N (%)	Total
Deficits	1 (3)	1 (0.3)	2 (0.5)
Intubation	6 (19)	63 (18)	69 (17)
Trauma	31 (100)	108 (29)	138 (34)
Convulsion	3 (10)	30 (8)	33 (8)
Headache	8 (26)	30 (8)	38 (9)
≥ 1 present	31	209 (56%)	240
None present	0	167 (44%)	167
Total	31	376	407

Sensitivity 31/31 = 100%. Specificity 167/376 = 44%. Positive predictive value 31/240 = 13%. Negative predictive value 167/167 = 100%.

Table 3. DITCH clinical features in poisoned patients according to whether they did or did not undergo head CT.

	Neuro Deficits (%)	Intubation (%)	Trauma (%)	Convulsion (%)	Headache (%)
No head CT performed (n = 901)	0	20 (2)	36 (4)	14 (2)	29 (3)
Head CT performed (n = 407)	2 (0.5)	69 (17)	138 (34)	33 (8)	38 (9)

Data availability statement

Data available upon reasonable request