Clinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans.

Autor: Plasencia-Martínez JM; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain. Plasen79@gmail.com., Otón-González E; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain., Sánchez-Canales M; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain., Ortiz-Mayoral H; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain., Cotillo-Ramos E; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain., Casado-Alarcón NI; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain., Ballesta-Ruiz M; Epidemiology and Public Health, Consejería de Salud Regional. IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain., Villaverde-González R; Department of Neurology, Hospital General Universitario Morales Meseguer, Murcia, Spain., García-Santos JM; Department of Radiology, Hospital General Universitario Morales Meseguer, Murcia, Spain.
Jazyk: angličtina
Zdroj: Emergency radiology [Emerg Radiol] 2024 Dec; Vol. 31 (6), pp. 835-843. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1007/s10140-024-02274-6
Abstrakt: Purpose: Fifty percent of cranial CT scans performed achieve no benefit and entail risks. Our aim is to determine the yield of non-traumatic urgent cranial-CT and develop a pretest clinical probability scale approach.
Methods: Adult patients seen in our emergency department between 2017-2021 and referred for urgent cranial-CT for non-traumatic reasons were retrospectively recruited and randomly selected. Presenting complaint (PC), demographic variables, Relevant radiological findings (RRF) on the urgent cranial-CT and Relevant clinical-radiological findings (RCRF: admission need or RRF detection on the urgent cranial-CT or cranial CT/MRI in the following three months) were recruited.
Results: We recruited 702 patients, with median age 62 [47-76] years, 363 (51.7%) females. RCRF were observed in 404 (57.55%); of these, 352 (50.1%) required admission. RRF were detected in 190 (27.06%): 36 acute ischemic and 27 acute hemorrhagic lesions, 115 masses, 9 edema, and 27 hydrocephalus. Predictive PC for urgent cranial-CT were motor, speech, sensory deficits, sudden alteration of mental status, epileptic seizure, cognitive impairment, neurological symptoms in cancer patients, acute headache without a prior history and with meningeal signs; nausea, vomiting, or hypertensive crisis; visual deficits, and dizziness. This algorithm provided sensitivity, specificity, positive predictive value, and negative predictive value (NPV, 95%CI in brackets) of 92.1% (89-94.5%), 27.5% (22.5-33.0%), 63.3% (59.2-67.2%), and 71.9% (62.7-80.0%), to diagnose RCRF, and 97.4% (93.4-99.1%), 21.3% (17.8-25.1%), 31.5% (27.7-35.4%), and 95.6% (90.1-98.6%), to diagnose RRF. In patients not requiring admission (n = 350), the NPV for RRF was 98.8% (93.6-100%); the negative likelihood ratio 0.08 (0.01-0.57), and sensitivity remained at 97.8% (82.2-99.9%). Applying it would have avoided performing 85/350 urgent cranial-CT (24.29%). To find one RRF, we would have gone from performing 7.8 (350/45) to 5.9 (265/45) CTs, failing to diagnose 1/45 (2.2%) RRF.
Conclusions: This proposed clinical scale could potentially decrease 24% of urgent cranial-CT.
Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Committee of our Institution (24 January 2022, internal code CETI 02/22). Informed consent was waived by Research Committee of our Institution. The manuscript does not contain figures of individual patients requiring their express consent. Conflict of interests: The authors declare no conflict of interest.
(© 2024. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).)
Databáze: MEDLINE
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