Cranial computed tomographic scans in elderly people – how often do they influence clinical management?

Fielding's study ‘The value of cranial computed tomography in old age psychiatry: a review of the results of 178 consecutive scans’ (Psychiatric Bulletin, January 2005, 29, 21–23) assessed the value of cranial computed tomographic (CT) scans in the elderly population and evaluated the recommendations of the Royal College of Psychiatrists on the selection of patients for scanning. However, the article was erroneous in stating that the College recommends all patients to be scanned unless the ‘ history is typical OR history greater than 1 year’. The College in fact recommends that all patients receive a scan ‘unless the patient has a history of more than a year AND there is a typical clinical picture’ (Royal College of Psychiatrists, 1995).

The author concluded that the study added validity to the College's criteria and suggested that cranial CT scans might influence patient management. I conducted an audit review of 56 cranial CT scans in elderly people. In 51%, clinical management was not influenced by the CT scan. This group included those who were unwilling to receive treatment. Fielding stated that the prevalence of truly reversible causes of dementia identified by cranial CT is extremely low. In support of this, in my audit review none of the scan results showed evidence of potentially reversible causes of dementia.