Role of Computed Tomography Brain Scans in Evaluating Geriatric Patients with Generalized Weakness in the Emergency Department: A Retrospective Multicenter Study

Objectives: Computed tomography (CT) scans are commonly used to evaluate the brain in geriatric patients presenting to emergency department (ED). Our study retrospectively aimed to evaluate the effectiveness of CT scans in diagnosing generalized weakness in elderly patients. Methods: Elderly patients (age ≥ 65 years) presenting to the ED with generalized weakness and either fatigue, dizziness, vertigo, fever, nausea, or vomiting between 1 January and 31 December 2022 were included from two prominent EDs in Muscat. Multiple variables were coded and systematically analyzed. Results: Out of 12 608 847 patients, 6.7% presented with generalized weakness and underwent a CT scan of the brain as part of their evaluation. The mean age was 76.0 ± 7.7 years, with males comprising 47.5% of the group. Presenting complaints to the ED were fever (57.0%), drowsiness (46.9%), and dizziness (30.0%). CT brain findings included acute ischemic changes (3.3%), subacute ischemic changes (7.8%), acute-on-chronic subdural hematoma or intracranial hematoma (3.4%), and new space-occupying lesions or abscesses (4.4%). Receiver operating characteristic curves assessed the diagnostic performance of CT imaging for various conditions: acute/subacute ischemic cerebrovascular accident (area under the curve (AUC) = 0.47, optimal threshold: 0.188), acute/acute on chronic subdural hematoma or intracranial hemorrhage (AUC = 0.41, optimal threshold: 0.122), significant new and/or acute CT findings overall (AUC = 0.45, optimal threshold: 0.026), and newly detected space occupying lesions (AUC = 0.43, optimal threshold: 0.144). Conclusions: A CT scan is limited as a diagnostic tool for patients presenting with generalized weakness, particularly in diagnosing new or acute/subacute medical or surgical conditions of the brain.