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

IF 1.7 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Emergency Radiology Pub Date : 2024-07-26 DOI:10.1007/s10140-024-02274-6

Juana María Plasencia-Martínez, Elena Otón-González, Marta Sánchez-Canales, Herminia Ortiz-Mayoral, Estefanía Cotillo-Ramos, Nuria Isabel Casado-Alarcón, Mónica Ballesta-Ruiz, Ramón Villaverde-González, José María García-Santos

{"title":"Clinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans.","authors":"Juana María Plasencia-Martínez, Elena Otón-González, Marta Sánchez-Canales, Herminia Ortiz-Mayoral, Estefanía Cotillo-Ramos, Nuria Isabel Casado-Alarcón, Mónica Ballesta-Ruiz, Ramón Villaverde-González, José María García-Santos","doi":"10.1007/s10140-024-02274-6","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emergency Radiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s10140-024-02274-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

从一项回顾性研究中得出的临床预测量表方法，以减少紧急、低价值头颅 CT 扫描的次数。

目的50%的头颅 CT 扫描无益且存在风险。我们的目的是确定非创伤性紧急头颅 CT 的收益率，并开发一种预检临床概率量表方法：回顾性招募并随机选取 2017-2021 年间在我院急诊科就诊、因非创伤性原因转诊进行紧急头颅 CT 检查的成人患者。招募内容包括主诉（PC）、人口统计学变量、急诊头颅 CT 相关放射学结果（RRF）和相关临床放射学结果（RCRF：入院需求或急诊头颅 CT 或头颅 CT/MRI 在随后三个月内检测到的 RRF）：我们共招募了 702 名患者，中位年龄为 62 [47-76] 岁，其中女性 363 人（51.7%）。404例（57.55%）患者出现RCRF，其中352例（50.1%）需要入院治疗。190人（27.06%）发现了RRF：其中急性缺血性病变 36 例，急性出血性病变 27 例，肿块 115 例，水肿 9 例，脑积水 27 例。急诊头颅 CT 的预测 PC 为运动、言语、感觉障碍、突然的精神状态改变、癫痫发作、认知障碍、癌症患者的神经系统症状、无既往史且伴有脑膜体征的急性头痛、恶心、呕吐或高血压危象、视觉障碍和头晕。该算法的灵敏度、特异性、阳性预测值和阴性预测值（NPV，括号内为 95%CI）分别为 92.1%（89-94.5%）、27.5%（22.5-33.0%）、63.3%（59.2-67.2%）和 71.9%（62.7-80.0%），诊断 RCRF，97.4%（93.4-99.1%）、21.3%（17.8-25.1%）、31.5%（27.7-35.4%）和 95.6%（90.1-98.6%）诊断 RRF。在无需入院的患者（n = 350）中，RRF 的 NPV 为 98.8% (93.6-100%)；负似然比为 0.08 (0.01-0.57)，灵敏度仍为 97.8% (82.2-99.9%)。采用该方法可避免进行 85/350 例紧急头颅 CT（24.29%）。为了发现一个RRF，我们将从进行7.8（350/45）次CT减少到5.9（265/45）次，未能诊断出1/45（2.2%）个RRF：结论：这一拟议的临床量表有可能减少 24% 的紧急头颅 CT。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Emergency Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.60

自引率

4.50%

发文量

期刊介绍： To advance and improve the radiologic aspects of emergency careTo establish Emergency Radiology as an area of special interest in the field of diagnostic imagingTo improve methods of education in Emergency RadiologyTo provide, through formal meetings, a mechanism for presentation of scientific papers on various aspects of Emergency Radiology and continuing educationTo promote research in Emergency Radiology by clinical and basic science investigators, including residents and other traineesTo act as the resource body on Emergency Radiology for those interested in emergency patient care Members of the American Society of Emergency Radiology (ASER) receive the Emergency Radiology journal as a benefit of membership!