Diagnostic yield and clinical impact of brain CT in palliative care: a retrospective single-center study of 215 examinations in 196 patients

Introduction: Brain computed tomography (CT) is frequently requested for neurological symptoms in palliative care, but its diagnostic yield and impact on management remain uncertain.Methods: This retrospective single-center study included 215 brain CT examinations performed in 196 adult patients hospitalized in a palliative care unit between January 2024 and June 2026. The unit of analysis was the CT examination, and repeated examinations were clustered by patient. The primary outcome was a change in clinical management within 24–48 hours. Exact tests and generalized estimating equation (GEE) models with robust standard errors were used.Results: The mean patient age was 67.6 ± 17.6 years, and 117 of 196 patients (59.7%) were male. The most frequent CT indications were altered consciousness (75/215, 34.9%), no specific documented indication (50/215, 23.3%), and seizure (45/215, 20.9%). CT findings were normal in 5 examinations (2.3%), chronic/non-specific in 155 (72.1%), acute in 20 (9.3%), and elective/actionable in 35 (16.3%). Acute clinically meaningful findings occurred in 25/215 (11.6%; 95% CI 8.0–16.6%), and management changed after 40/215 examinations (18.6%; 95% CI 14.0–24.3%). Objective neurological findings were associated with both an acute clinically meaningful CT result (27.8% vs. 0%; p<0.001) and management change (38.9% vs. 4.0%; cluster-adjusted OR=16.16, 95% CI 6.06–43.11; p<0.001). Management changed in 30/55 (54.5%) acute/elective examinations versus 10/160 (6.2%) normal/chronic examinations (cluster-adjusted OR=17.75, 95% CI 7.69–40.99; p<0.001). By the predefined operational criterion, 175/215 examinations (81.4%) were potentially unnecessary.Conclusions: Most brain CT examinations in this palliative care cohort did not identify an acute clinically meaningful abnormality or alter management. Objective neurological findings identified a higher-yield subgroup. Brain CT should be used selectively in appropriate indications and when a change in the patient's current treatment is being considered.