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Neuroimaging (NI) can help determine whether a patient's symptom (i.e., seizure) results from a structural abnormality of the brain or its surroundings, and it is useful in a variety of clinical settings. Patients may report seizure-related symptoms (e.g., simple partial or complex partial seizures) to their primary care provider prompting neurologic evaluation, or a sudden convulsive episode may hasten medical care through an emergency department (ED).
In an ED, the medical staff evaluates the patient to determine the nature of the event, performs diagnostic studies, begins treatment when appropriate, and arranges disposition or follow-up care. The nature of the event is best determined by historical observations from the patient or witnesses. Diagnosis is determined primarily from history and physical examination findings but may be supported by ancillary studies. Treatment decisions and disposition depend on the cumulative results of the evaluation.
The practitioner's decision to order a test must include an assessment of available resources. In the case of NI, this may include limited NI availability in the ED or other limited resources. The decision for emergency NI may result in retriage or reprioritizing patients for available scan time and, in some locations, may lead to a mobilization of equipment or personnel. The patient's clinical status and stability must be ensured before referral for imaging. Assuming that NI is useful in the evaluation of a patient with seizures, critical review of the role and timing of this test in the spectrum of emergency care is the subject of this report.
A panel representing the American Academy of Neurology, American College of Emergency Physicians, and the American Association of Neurological Surgeons convened to examine the available evidence concerning the use of NI in the ED setting. The panelists chosen were recommended by their organizations' practice parameters development group. The panel decided by …
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