Reinus W R, Erickson K K, Wippold F J
Department of Radiology, Jewish Hospital, Washington University Medical Center, St Louis, MO 63110.
Radiology. 1993 Mar;186(3):763-8. doi: 10.1148/radiology.186.3.8430185.
Charts from 1,074 consecutive emergency department patients who underwent cranial computed tomography (CT) were reviewed for predictors of a CT abnormality. Twenty-six clinical variables and the results of neurologic examination were compared with cranial CT findings. Patients with focal neurologic deficit, unresponsiveness, and hypertension had an increased risk of a CT abnormality. Blurred vision, trauma, loss of consciousness, headache, and dizziness were each associated with a lower risk of a CT abnormality. Multivariate analysis showed that only focal neurologic deficit and unresponsiveness effectively helped predict a CT abnormality. In patients with negative neurologic findings, only intoxication and amnesia were associated with greater than 10% positive scans and an increased risk for a CT abnormality. The data indicate that positive neurologic findings coupled with intoxication and amnesia would have helped detect 90.7% of the positive scans and provide an effective initial approximation strategy for selecting patients to undergo CT. Although 15 patients with positive scans (1.4%) would have been missed, this strategy would have yielded a negative predictive value of 97.3% and eliminated 53.9% of the CT scans obtained.
对1074例连续在急诊科接受头颅计算机断层扫描（CT）的患者的病历进行回顾，以寻找CT异常的预测因素。将26项临床变量和神经系统检查结果与头颅CT结果进行比较。有局灶性神经功能缺损、无反应和高血压的患者CT异常风险增加。视力模糊、外伤、意识丧失、头痛和头晕与CT异常风险较低相关。多因素分析显示，只有局灶性神经功能缺损和无反应能有效帮助预测CT异常。在神经系统检查结果为阴性的患者中，只有中毒和失忆与阳性扫描率大于10%及CT异常风险增加相关。数据表明，阳性神经系统检查结果加上中毒和失忆有助于检测出90.7%的阳性扫描，并为选择接受CT检查的患者提供有效的初步近似策略。虽然会漏诊15例阳性扫描患者（1.4%），但该策略的阴性预测值将为97.3%，并减少53.9%的CT扫描检查。
