Prospective evaluation of selected clinical criteria for cranial computed tomography in non‐trauma adult patients

Tan, Ik Lin; Young, Noel; Sindhusake, Doungkamol; Boddy, Rachel; Bui, Quoc; Nagra, Ravinder; Reddy, Jyothi G.

doi:10.1111/j.1742-6723.2008.01151.x

Cited by 7 publications

(10 citation statements)

References 14 publications

(34 reference statements)

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“…The prevalence of focal neurologic findings that we observed in patients without trauma who had abnormalities on CCT (61 of 83, 73%) is strikingly similar to the 72% reported by Rothrock et al 3 and the 72.5% reported by Tan and colleagues 5 . Among 12 patients who underwent emergent therapeutic interventions, 11 had focal neurologic findings on clinical examination for a sensitivity of 91.7%.…”

Section: Discussionsupporting

confidence: 86%

“…The prevalence of abnormal CCTs that we observed (8%) was the same as that reported by Rothrock and colleagues 3 in their study of 806 patients, but lower than the rates reported by Harris and colleagues 4 and Tan and colleagues 5 . Harris and colleagues 4 only studied 62 patients, and both Harris et al 4 and Tan et al 5 attributed their higher rates of CCT abnormalities to their physicians being more selective when ordering CCTs.…”

Section: Discussionsupporting

confidence: 83%

“…Abnormalities found on the CCT that were considered to be clinically important included acute ischemic or hemorrhagic stroke, any intracranial hemorrhage, intracranial neoplasm (benign, malignant, or metastatic), infection, vascular malformation, obstructive hydrocephalus, and cerebral edema, in accordance with previous studies 3–5,9,10 . AMS was defined as any impairment of awareness, cognition, or attention.…”

Section: Methodsmentioning

confidence: 90%

“…Cranial computed tomography (CCT) is commonly used to evaluate patients presenting to the emergency department (ED) with a myriad of complaints or findings 1,2 . The prevalence of clinically important abnormalities on CCT in patients presenting with a variety of neurologic complaints including altered mental status (AMS) in absence of head trauma varies, ranging from 8% to 35%, 3–5 but no study has examined the frequency with which information obtained from the CCTs of these patients leads to emergent therapeutic interventions.…”

mentioning

confidence: 99%

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Utility of Emergency Cranial Computed Tomography in Patients Without Trauma

Narayanan

Keniston

Albert

2012

Academic Emergency Medicine

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Objectives: The objectives of this study were to determine, in patients admitted to the hospital from the emergency department (ED) without evidence of trauma, 1) the prevalence of clinically important abnormalities on cranial computed tomography (CCT) and 2) the frequency of emergent therapeutic interventions required because of these abnormalities. Methods:The authors retrospectively reviewed the records of all patients from 2007 between the ages of 18 and 89 years who had CCT as part of their ED evaluations prior to hospitalization. Patients with any indication of trauma were excluded, as were those who had a lumbar puncture (LP). Chief complaint, results of the ED neurologic examination, tomogram findings, and whether patients had emergent interventions were recorded. Patients presenting with altered mental status (AMS) were analyzed separately.Results: Of the 766 patients meeting inclusion criteria, 83 (11%) had focal neurologic findings, and 61 (8%) had clinically important abnormalities on computed tomography. Emergent interventions occurred in only 12 (1.6%), 11 (92%) of whom had focal neurologic findings. In the subgroup of 287 patients with AMS as their presenting problem, 14 (4.9%) had focal findings, six (2%) had clinically important abnormalities on tomography, and only two (0.7%) required emergent interventions, both of whom had focal findings. Patients presenting with AMS were less likely to have positive findings on tomography (odds ratio [OR] = 0.16, 95% confidence interval [CI] = 0.07 to 0.39). Patients presenting with motor weakness or speech abnormalities, or who were unresponsive, were more likely to have positive findings on tomography (OR = 4.7, 95% CI = 2.6 to 8.6; OR = 4.4, 95% CI = 1.5 to 2.7; and OR = 3.3, 95% CI = 1.6 to 7.1, respectively). Conclusions:Of patients without evidence of trauma who receive CCT in the ED, the prevalence of focal neurologic findings and clinically important abnormalities on tomography is low, the need for emergent intervention is very low, and the large majority of patients requiring emergent intervention have focal findings. The yield of CCT was lower for patients presenting with AMS, and higher for patients presenting with motor weakness or speech abnormalities, and for those who were unresponsive.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 90%

mentioning

confidence: 99%

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Utility of Emergency Cranial Computed Tomography in Patients Without Trauma

Narayanan

Keniston

Albert

2012

Academic Emergency Medicine

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“…These criteria include those by Rothrock et al , Harris et al , Wang and You and Bent et al (Table ). In particular, the Rothrock and Harris criteria have both been validated previously, and their initial, high sensitivities and scan reduction rates have not been reproducible …”

Section: Introductionmentioning

confidence: 99%

Clinical decision rule for non‐traumatic computed tomography of the brain

Scott-King

Tieu

Chiew

et al. 2019

Emerg Medicine Australasia

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Objective: The aims of the present study were to derive and validate a clinical decision rule (CDR) to rule out the need for computed tomography of the brain (CTB) in nontraumatic patients who present to the ED. Methods: This is a retrospective review of non-traumatic patients who presented to the EDs in two urban hospitals and received CTB from January 2014 to December 2016. Data from one hospital were used to develop a CDR for clinically significant CTB findings. Clinically significant CTB findings were defined as acute infarction, intracranial neoplasm, intracranial haemorrhage, acute hydrocephalus, cerebral oedema and intracranial infection. Patients from another hospital were used as a validation cohort to evaluate the CDR and compare it to four previously derived CDRs.Results: There were 5296 cases in the derivation cohort, with 345 (6.5%) clinically significant CTB findings. Identified risk factors were: focal neurological deficit (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 2.6-4.4), Glasgow Coma Scale <15 (adjusted OR 3.5, 95% CI 2.6-4.6), history of malignancy (adjusted OR 3.2, 95% CI 2.4-4.2), nausea and/or vomiting (adjusted OR 1.6, 95% CI 1.1-2.1), headache (adjusted OR 1.1, 95% CI 0.9-1.5) and coagulopathy (adjusted OR 9.2, 95% CI 2.1-41.5). These criteria and four pre-existing CDRs were applied to the validation cohort of 5098 patients from the second hospital, which had 338 (6.6%) clinically significant CTB findings. Our criteria were found to have a sensitivity of 99.7% (95% CI 99.1-100.0) and a specificity of 11.0% (95% CI 10.1-11.9). The risk of having a clinically significant CTB finding is 0.3% if patients do not meet any of the criteria. Conclusion: The CDR derived in the present study achieved the highest sensitivity and a moderate specificity when compared with four other pre-existing CDRs for nontraumatic brain injury patients.• Create a useful CDR for clinicians to identify low-risk patients for non-traumatic brain injury. • Hence decrease harmful, costly, over-scanning of patients with CT brain.

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Akutes fokal-neurologisches Defizit in der Notaufnahme

Dohmen

Bösel

2017

Nervenarzt

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A focal neurological deficit with sudden onset or rapid progression is an alarming symptom indicating a neurological disorder with often urgent need for treatment. Particularly in the emergency room, where time and resources are limited, it is necessary to rapidly assign such a focal neurological deficit to a certain syndrome and to define a suspected diagnosis in order to execute the correct diagnostics and emergency therapy. In this article, we highlight frequent and typical neurological disorders presenting in the emergency room and their corresponding focal neurological deficits. The article and a suggested algorithm are to guide less-experienced colleagues to find quick steps from acute symptoms to diagnosis and emergency treatment of frequent and relevant neurological disorders in the emergency room.

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Prospective evaluation of selected clinical criteria for cranial computed tomography in non‐trauma adult patients

Cited by 7 publications

References 14 publications

Utility of Emergency Cranial Computed Tomography in Patients Without Trauma

Utility of Emergency Cranial Computed Tomography in Patients Without Trauma

Clinical decision rule for non‐traumatic computed tomography of the brain

Akutes fokal-neurologisches Defizit in der Notaufnahme

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