Treatment of primary causes of psychosis involves pharmacologic management with antipsychotic medications, psychological therapy, and psychosocial interventions [13]. This article focuses on the appropriateness of neuroimaging in adult patients presenting with AMS changes including new onset delirium or new onset psychosis. In these cases, imaging is often expedited for initial stabilization and to exclude an intracranial process requiring intervention. The diagnosis of delirium in the ED setting can be missed by inadequate screening [3,14], although ED physicians are moderately accurate at establishing the correct clinical diagnosis for the cause of AMS within the first 20 minutes of the patient encounter [15]. The complete evaluation for underlying causes, such as chest radiography to assess for pneumonia, electrocardiogram to assess for myocardial ischemia, electroencephalography for suspected convulsive or nonconvulsive seizure, and lumbar puncture to assess for central nervous system infection, is beyond the scope of this article [3,7]. OR Discussion of Procedures by Variant Variant 1: Adult. Altered mental status. Suspected intracranial pathology or focal neurologic deficit. Initial imaging. Identifying patients with AMS or delirium secondary to acute intracranial pathology is extremely important to guide management and ensure early appropriate triage. This variant encompasses a select group of patients presenting with acute mental status changes at a relatively higher risk of acute intracranial pathology. The yield of neuroimaging studies in patients with AMS is low. A recent meta-analysis of 25 studies including a total of 79,201 patients with atraumatic AMS showed that 94% had undergone a head CT examination, with relevant abnormal findings in only 11% [24]. In a large study of more than 708,145 adult ED encounters, 58,783 CT head Altered Mental Status, Coma, Delirium, and Psychosis
Altered Mental Status Coma Delirium and Psychosis. Treatment of primary causes of psychosis involves pharmacologic management with antipsychotic medications, psychological therapy, and psychosocial interventions [13]. This article focuses on the appropriateness of neuroimaging in adult patients presenting with AMS changes including new onset delirium or new onset psychosis. In these cases, imaging is often expedited for initial stabilization and to exclude an intracranial process requiring intervention. The diagnosis of delirium in the ED setting can be missed by inadequate screening [3,14], although ED physicians are moderately accurate at establishing the correct clinical diagnosis for the cause of AMS within the first 20 minutes of the patient encounter [15]. The complete evaluation for underlying causes, such as chest radiography to assess for pneumonia, electrocardiogram to assess for myocardial ischemia, electroencephalography for suspected convulsive or nonconvulsive seizure, and lumbar puncture to assess for central nervous system infection, is beyond the scope of this article [3,7]. OR Discussion of Procedures by Variant Variant 1: Adult. Altered mental status. Suspected intracranial pathology or focal neurologic deficit. Initial imaging. Identifying patients with AMS or delirium secondary to acute intracranial pathology is extremely important to guide management and ensure early appropriate triage. This variant encompasses a select group of patients presenting with acute mental status changes at a relatively higher risk of acute intracranial pathology. The yield of neuroimaging studies in patients with AMS is low. A recent meta-analysis of 25 studies including a total of 79,201 patients with atraumatic AMS showed that 94% had undergone a head CT examination, with relevant abnormal findings in only 11% [24]. In a large study of more than 708,145 adult ED encounters, 58,783 CT head Altered Mental Status, Coma, Delirium, and Psychosis