Diagnostic Yield of Brain CT by Clinical Indication at Azadi Teaching Hospital, Duhok: A Cross-sectional Study

Abstract

Objective: To describe the frequency of abnormal brain Computed Tomography (CT) examinations among patients referred to Azadi Teaching Hospital, Duhok, Iraq, and to compare abnormal-finding rates across recorded clinical indication, age group, and sex. The study did not adjudicate whether individual CT requests were clinically appropriate.

Methods: This prospective cross-sectional observational study assessed patients referred for brain CT at Azadi Teaching Hospital between January and May 2026. Patients with incomplete required study data were excluded before inclusion in the final study dataset. A total of 198 eligible participants with complete data were included. The primary outcome was the binary radiology-record classification of normal versus abnormal CT. Associations were examined using chi-square or Fisher’s exact tests as appropriate; effect size was summarised using Cramér’s V with 95% confidence intervals estimated by non-parametric bootstrap resampling.

Results: Among 198 participants (98 male, 100 female), the most frequent recorded indications were headache (n=73), loss of consciousness (n=65), road traffic accident with head injury (n=20), and seizure disorder (n=17). Overall, 115/198 examinations were classified as abnormal (58.1%; 95% CI 51.1–64.7%). Abnormal-finding rates differed across the five grouped referral categories (χ²=29.746, df=4, p<0.001, Cramér’s V=0.388, 95% CI 0.280–0.524) and across age groups (χ²=15.880, df=3, p=0.001, Cramér’s V=0.283, 95% CI 0.176–0.421), but not by sex (χ²=0.097, df=1, p=0.756, Cramér’s V=0.022, 95% CI 0.002–0.167).

Conclusion: The proportion of examinations classified as abnormal varied substantially by recorded referral indication and age. These data describe diagnostic yield only; they do not establish whether an individual CT request was appropriate, because guideline-based case-level appropriateness and the clinical relevance of each positive finding were not adjudicated. Future prospective multicenter studies should incorporate indication-specific decision criteria and classify findings as clinically related/actionable, incidental intracranial, extracranial, or normal.