Bent Christopher, Lee Paul S, Shen Peter Y, Bang Heejung, Bobinski Mathew
Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, Sacramento, CA, 95816, USA.
Department of Public Health Sciences, Division of Biostatistics, University of California, Davis School of Medicine, Sacramento, CA, USA.
Emerg Radiol. 2015 Oct;22(5):511-6. doi: 10.1007/s10140-015-1305-x. Epub 2015 Mar 13.
The positive rate of head CT in non-trauma patients presenting to the emergency department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and three derived algorithms. Positive CTs were found in 51 of 500 patients (10.2 %). Only two clinical factors were significant: focal neurologic deficit (adjusted odds ratio (OR) 20.7; 95 % confidence interval (CI) 9.4-45.7) and age >55 (adjusted OR 3.08; CI 1.44-6.56). Area under the ROC curve for all three algorithms was 0.73-0.83. In proposed algorithm C, only patients with focal neurologic deficit (major risk factor) or ≥2 of the five minor risk factors (altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age) would undergo CT imaging. This may reduce utilization by 34 % with only a small decrease in sensitivity (98 %). Our simple scoring algorithm utilizing multiple clinical risk factors could help to predict the non-trauma patients who will benefit from CT imaging, resulting in reduced radiation exposure without sacrificing sensitivity.
急诊科（ED）非创伤患者头部CT的阳性率较低。目前，影像学检查的指征基于主治医生的个人经验，这导致了影像学检查的过度使用和使用的变异性。本研究的目的是确定非创伤患者头部CT阳性的预测因素，并证明一种临床评分算法提高检出率的可行性。我们回顾性分析了500例连续的ED非创伤患者，这些患者在出现头痛、意识改变、晕厥、头晕或局灶性神经功能缺损后接受了非增强头部CT检查。评估病历中的临床危险因素：局灶性神经功能缺损、精神状态改变、恶心/呕吐、已知恶性肿瘤、凝血功能障碍和年龄。使用逻辑回归和受试者操作特征（ROC）曲线以及三种衍生算法对数据进行分析。500例患者中有51例（10.2%）CT结果为阳性。只有两个临床因素具有显著意义：局灶性神经功能缺损（调整后的优势比（OR）为20.7；95%置信区间（CI）为9.4 - 45.7）和年龄>55岁（调整后的OR为3.08；CI为1.44 - 6.56）。三种算法的ROC曲线下面积为0.73 - 0.83。在提议的算法C中，只有具有局灶性神经功能缺损（主要危险因素）或五个次要危险因素（精神状态改变、恶心/呕吐、已知恶性肿瘤、凝血功能障碍和年龄）中≥2个的患者才会接受CT成像。这可能会减少34%的检查使用量，而敏感性仅略有下降（98%）。我们利用多种临床危险因素的简单评分算法有助于预测哪些非创伤患者将从CT成像中获益，从而在不牺牲敏感性的情况下减少辐射暴露。
