Kotisaari Kaisa, Virtanen Pekka, Forss Nina, Strbian Daniel, Scheperjans Filip
Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland; Clinical Neurosciences, Neurology, University of Helsinki, Finland.
Department of Radiology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland; Radiology, University of Helsinki, Helsinki, Finland.
Seizure. 2017 May;48:89-93. doi: 10.1016/j.seizure.2017.04.009. Epub 2017 Apr 17.
To determine the frequency of emergent imaging findings on head computed tomography (CT) in an adult population of first seizure (FS) patients presenting to an emergency department (ED); and to search for associations between clinical features and emergent imaging findings among these patients.
For this retrospective registry-based study, adult FS patients presenting to Helsinki University Hospital ED in 2006 were identified based on ICD-10 diagnosis. Clinical parameters were extracted from patient records. A neuroradiologist blinded to clinical information reviewed the CT scans for emergent imaging findings prompting changes in acute treatment, predefined as intracranial haemorrhage, acute ischemia, central nervous system infection, mass effect, midline shift, obstructive hydrocephalus and/or brain oedema.
449 FS patients were identified, of which 416 (93%) had undergone emergency CT imaging. Of these, 49 (12%) had emergent imaging findings on non-contrast CT. Logistic regression suggested that headache (odds ratio (OR) 3.62, 95% confidence interval (CI) 1.30-10.12), focal motor sign in the ED (OR 3.23, 95% CI 1.58-6.62), history of malignancy (OR 3.05, 95% CI 1.17-7.92), and altered mental state in the ED (OR 2.27, 95% CI 1.15-4.49) were associated with emergent imaging findings on NCCT. Presence of at least one of these factors had 84% sensitivity for emergent imaging findings.
In FS patients, clinical information can be used to guide imaging decisions in the ED. However, if emergency imaging is not performed, urgent outpatient imaging and pre-imaging follow up should be secured.
确定在急诊科就诊的首次癫痫发作（FS）成年患者中，头部计算机断层扫描（CT）出现紧急影像表现的频率；并探寻这些患者临床特征与紧急影像表现之间的关联。
对于这项基于回顾性登记的研究，根据国际疾病分类第10版（ICD - 10）诊断确定2006年在赫尔辛基大学医院急诊科就诊的成年FS患者。从患者记录中提取临床参数。一名对临床信息不知情的神经放射科医生查看CT扫描，以寻找提示急性治疗方案改变的紧急影像表现，预先定义为颅内出血、急性缺血、中枢神经系统感染、占位效应、中线移位、梗阻性脑积水和/或脑水肿。
共确定449例FS患者，其中416例（93%）接受了急诊CT成像。在这些患者中，49例（12%）在非增强CT上有紧急影像表现。逻辑回归分析表明，头痛（优势比（OR）3.62，95%置信区间（CI）1.30 - 10.12）、急诊科出现局灶性运动体征（OR 3.23，95% CI 1.58 - 6.62）、恶性肿瘤病史（OR 3.05，95% CI 1.17 - 7.92）以及急诊科精神状态改变（OR 2.27，95% CI 1.15 - 4.49）与非增强CT上的紧急影像表现相关。这些因素中至少存在一项对紧急影像表现的敏感度为84%。
在FS患者中，临床信息可用于指导急诊科的影像检查决策。然而，如果未进行急诊影像检查，则应确保进行紧急门诊影像检查及影像检查前的随访。
