Urgent Need for Head CT in Older Adults with Delirium, Study Finds

A recent study published in The American Journal of Emergency Medicine on May 16, 2025, underscores the critical necessity of performing head CT scans on older adults presenting with delirium in emergency departments. The research revealed that approximately 15.6% of patients aged 65 and older exhibited acute intracranial abnormalities, even in the absence of traditional risk factors such as anticoagulant use and recent head trauma.

Lead researcher Dr. James O. Jordano, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, spearheaded the study, which involved a secondary analysis of two prospective observational studies conducted between 2009 and 2014. The research encompassed 160 patients with delirium, with a median age of 76 years, of whom 62.5% were women and 20% non-White. The primary outcome measure was defined as a 'positive composite head CT,' indicating any acute intracranial abnormality either during hospitalization or a new neurologic diagnosis within 30 days post-ED visit.

The study methodically assessed the diagnostic performance of five commonly cited risk factors for intracranial pathology, including focal neurologic deficits and altered levels of consciousness. Surprisingly, the absence of these risk factors did not significantly decrease the likelihood of a positive head CT scan (negative likelihood ratio [NLR] of 0.6; 95% confidence interval [CI], 0.2-2.4). Notably, only new or worsening seizures, as well as a history of brain hardware, moderately increased the probability of significant findings on the CT scan (positive likelihood ratio [PLR] of 5.4; 95% CI, 0.8-36.6).

The implications of this study are substantial. Dr. Jordano and his team concluded, 'Given the high rate of abnormal head CTs, our findings suggest that older emergency department patients with delirium should routinely undergo a head CT as part of their diagnostic workup, regardless of the presence of common risk factors.'

However, it is essential to acknowledge the study's limitations, including its single-center design and relatively small sample size, which may impact the generalizability of the findings. The researchers noted that the reliance on retrospective chart review could have led to misclassification of risk factors, and the exclusion of critically ill patients may have introduced selection bias.

The study received funding from the National Institutes of Health, the National Center for Research Resources, and the National Center for Advancing Translational Sciences. Importantly, the authors declared no conflicts of interest. This research adds a significant dimension to the existing literature on delirium in older adults, prompting a reevaluation of diagnostic protocols in emergency settings. As the population ages, understanding the nuances of delirium and its potential underlying causes becomes increasingly vital in delivering appropriate and timely medical care.