Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Neurology and Neurosurgery Pub Date : 2024-11-02 DOI:10.1016/j.clineuro.2024.108627
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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.
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验证诊断支持工具,以便在初级保健中及早识别宫颈动脉夹层
背景颈部动脉夹层(CeAD)是导致青壮年中风的主要原因之一,其早期症状通常表现为肌肉骨骼疼痛。目前还没有有效的检测方法,因此可能会漏诊颈部动脉夹层。目的验证用于初级保健中早期识别 CeAD 的 4 项标准诊断支持工具,根据需要完善工具描述,并提出临床应用的最佳临界值。设计前瞻性观察研究方法从因头痛或颈部疼痛到一家三级甲等医院就诊的 18 岁成年人中识别出经放射学确诊的 CeAD 患者和无 CeAD 的对照组。所有患者均按照7项标准(急性发作性疼痛[2]、近期外伤/感染[1]、神经系统特征[2]、55岁[2])进行评分。结果纳入了 30 名患有 CeAD 的患者和 261 名患有非 CeAD 引起的头痛和颈部疼痛的对照组患者。诊断支持工具是预测 CeAD 的 "优秀 "工具(AUC 0.83),但特异性较差。将该工具细化为 "急性/突然发作"[1]、"不寻常/不熟悉的头痛/颈痛"[1]、近期创伤/感染[1]和神经特征≥2[1],满分为 4 分,结果显示,在 3/4 分界时,检测 CeAD 的灵敏度为 100%,特异度为 74%(AUC 0.87)。需要在急诊和初级保健中进一步验证。
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
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.
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