{"title":"Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care","authors":"","doi":"10.1016/j.clineuro.2024.108627","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Cervical arterial dissection (CeAD) is a leading cause of stroke in young adults with an early presentation often mimicking musculoskeletal pain. Currently, no validated tests exist and CAD may be missed. A diagnostic support tool could help guide urgent referral for imaging, when to monitor, or when safe to proceed with treatment, and ultimately help stroke prevention.</div></div><div><h3>Objectives</h3><div>To validate a 4-criteria diagnostic support tool for early recognition of CeAD in primary care, to refine tool descriptors as needed, and propose optimal cut-offs for clinical application.</div></div><div><h3>Design</h3><div>Prospective observational study</div></div><div><h3>Method</h3><div>Participants with radiologically confirmed CeAD and controls without CeAD were identified from adults >18 years presenting to a tertiary metropolitan hospital with initial diagnosis of headache or neck pain. All were scored with criteria out of7 (acute onset pain [2], recent trauma/infection [1], neurological features [2], age <55 years [2]). Diagnostic values were calculated to determine cut offs and the tool was refined based on the analysis.</div></div><div><h3>Results</h3><div>Thirty participants with CeAD and 261 controls with non-CeAD causes of headache and neck pain were included. The diagnostic support tool was an ‘excellent’ predictor of CeAD (AUC 0.83) but demonstrated poor specificity. Refining the tool to ‘acute/sudden onset’ [1], ‘unusual/unfamiliar headache/neck pain’ [1], recent trauma/infection [1] and neurological features ≥2 [1], scored out of 4, showed 100 % sensitivity and 74 % specificity to detect CeAD at a cut-off of 3/4 (AUC 0.87).</div></div><div><h3>Conclusions</h3><div>The refined tool shows acceptable clinical utility at a cut-off ≥3, where referral for vascular imaging is recommended. Further validation in Emergency and primary care is needed.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0303846724005146","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Cervical arterial dissection (CeAD) is a leading cause of stroke in young adults with an early presentation often mimicking musculoskeletal pain. Currently, no validated tests exist and CAD may be missed. A diagnostic support tool could help guide urgent referral for imaging, when to monitor, or when safe to proceed with treatment, and ultimately help stroke prevention.
Objectives
To validate a 4-criteria diagnostic support tool for early recognition of CeAD in primary care, to refine tool descriptors as needed, and propose optimal cut-offs for clinical application.
Design
Prospective observational study
Method
Participants with radiologically confirmed CeAD and controls without CeAD were identified from adults >18 years presenting to a tertiary metropolitan hospital with initial diagnosis of headache or neck pain. All were scored with criteria out of7 (acute onset pain [2], recent trauma/infection [1], neurological features [2], age <55 years [2]). Diagnostic values were calculated to determine cut offs and the tool was refined based on the analysis.
Results
Thirty participants with CeAD and 261 controls with non-CeAD causes of headache and neck pain were included. The diagnostic support tool was an ‘excellent’ predictor of CeAD (AUC 0.83) but demonstrated poor specificity. Refining the tool to ‘acute/sudden onset’ [1], ‘unusual/unfamiliar headache/neck pain’ [1], recent trauma/infection [1] and neurological features ≥2 [1], scored out of 4, showed 100 % sensitivity and 74 % specificity to detect CeAD at a cut-off of 3/4 (AUC 0.87).
Conclusions
The refined tool shows acceptable clinical utility at a cut-off ≥3, where referral for vascular imaging is recommended. Further validation in Emergency and primary care is needed.
期刊介绍:
Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.