Incidental Detection of Previously Unknown Strokes on Head CT Examinations: An Untapped Opportunity for Secondary Prevention
Abstract
BACKGROUND
The incidental discovery of previously unknown strokes on neuroimaging is an opportunity to implement secondary prevention, reducing the risk of recurrent strokes by up to 80%.
OBJECTIVE
To evaluate the prevalence of previously unknown strokes on emergency department (ED) head CT imaging and identify associated patient and imaging factors.
METHODS
Retrospective study of adult patients receiving head CT (age ≥ 18 years) at 3 EDs between July and December 2023. Old strokes on CT imaging were categorized as previously known or unknown. Patient and imaging factors associated with unknown strokes were assessed via univariable regression, multivariable regression, and decision tree analysis.
RESULTS
In 21,985 ED encounters with head CT, 869 (4.0%) examinations demonstrated an old stroke (mean age, 74.4 years ± 14.0 [SD]), of which 372 (43%; 1.7% of all CTs) were unknown. Univariable analysis showed that unknown strokes were associated with greater age (OR, 1.03; 95% CI: 1.02-1.04; P < 0.001), a single site of old stroke (OR, 2.7; 95% CI: 2.06-3.58; P < 0.001), smaller strokes (OR, 1.8, 95% CI: 1.6-2.0, P <0.001) as well as gangliocapsular (OR, 2.8; 95% CI: 1.9-4.0; P < 0.001) and cerebellar location (OR, 2.1; 95% CI: 1.4-3.2; P < 0.001). Results of further analyses corroborated those of the univariable regression.
CONCLUSION
More than a third of old strokes on head CT imaging are unknown to patients and clinicians. Capturing this opportunity for secondary prevention…
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