ACR Appropriateness Criteria ® Acute Mental Status Change, Delirium, and New Onset Psychosis

Expert Panel on Neurological Imaging:

Research output: Contribution to journalArticle

Abstract

Acute changes in mental status represent a broad collection of symptoms used to describe disorders in mentation and level of arousal, including the more narrowly defined diagnoses of delirium and psychosis. A wide range of precipitating factors may be responsible for symptom onset including infection, intoxication, and metabolic disorders. Neurologic causes that may be detected on neuroimaging include stroke, traumatic brain injury, nonconvulsive seizure, central nervous system infection, tumors, hydrocephalus, and inflammatory disorders. Not infrequently, two or more precipitating factors may be found. Neuroimaging with CT or MRI is usually appropriate if the clinical suspicion for an acute neurological cause is high, where the cause of symptoms is not found on initial assessment, and for patients whose symptoms do not respond appropriately to management. There was disagreement regarding the appropriateness of neuroimaging in cases where a suspected, nonneurologic cause is found on initial assessment. Neuroimaging with CT is usually appropriate for patients presenting with delirium, although the yield may be low in the absence of trauma or a focal neurological deficit. Neuroimaging with CT or MRI may be appropriate in the evaluation of new onset psychosis, although the yield may be low in the absence of a neurologic deficit. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)S26-S37
JournalJournal of the American College of Radiology
Volume16
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Delirium
Neuroimaging
Psychotic Disorders
Precipitating Factors
Guidelines
Central Nervous System Infections
Central Nervous System Neoplasms
Expert Testimony
Hydrocephalus
Neurologic Manifestations
Arousal
Radiology
Nervous System
Seizures
Stroke
Wounds and Injuries
Therapeutics
Infection

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

ACR Appropriateness Criteria ® Acute Mental Status Change, Delirium, and New Onset Psychosis . / Expert Panel on Neurological Imaging:.

In: Journal of the American College of Radiology, Vol. 16, No. 5, 01.05.2019, p. S26-S37.

Research output: Contribution to journalArticle

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