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Clinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans

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dc.contributor.authorPlasencia Martínez, Juana María
dc.contributor.authorOtón González, Elena
dc.contributor.authorSánchez Canales, Marta
dc.contributor.authorOrtiz Mayoral, Herminia
dc.contributor.authorCotillo Ramos, Estefanía
dc.contributor.authorCasado‑Alarcón, Nuria Isabel
dc.contributor.authorBallesta Ruiz, Mónica
dc.contributor.authorVillaverde González, Ramón
dc.contributor.authorGarcía Santos, José María
dc.contributor.departmentCiencias Sociosanitarias
dc.contributor.otherFacultades de la UMU::Facultad de Enfermería
dc.date.accessioned2026-04-22T11:15:57Z
dc.date.available2026-04-22T11:15:57Z
dc.date.copyright© 2024, The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER)
dc.date.issued2024-07-26
dc.description.abstractPurpose: Fifty percent of cranial CT scans performed achieve no benefit and entail risks. Our aim is to determine the yield of non-traumatic urgent cranial-CT and develop a pretest clinical probability scale approach. Methods: Adult patients seen in our emergency department between 2017–2021 and referred for urgent cranial-CT for non-traumatic reasons were retrospectively recruited and randomly selected. Presenting complaint (PC), demographic variables, Relevant radiological findings (RRF) on the urgent cranial-CT and Relevant clinical-radiological findings (RCRF: admission need or RRF detection on the urgent cranial-CT or cranial CT/MRI in the following three months) were recruited. Results: We recruited 702 patients, with median age 62 [47–76] years, 363 (51.7%) females. RCRF were observed in 404 (57.55%); of these, 352 (50.1%) required admission. RRF were detected in 190 (27.06%): 36 acute ischemic and 27 acute hemorrhagic lesions, 115 masses, 9 edema, and 27 hydrocephalus. Predictive PC for urgent cranial-CT were motor, speech, sensory deficits, sudden alteration of mental status, epileptic seizure, cognitive impairment, neurological symptoms in cancer patients, acute headache without a prior history and with meningeal signs; nausea, vomiting, or hypertensive crisis; visual deficits, and dizziness. This algorithm provided sensitivity, specificity, positive predictive value, and negative predictive value (NPV, 95%CI in brackets) of 92.1% (89–94.5%), 27.5% (22.5–33.0%), 63.3% (59.2–67.2%), and 71.9% (62.7–80.0%), to diagnose RCRF, and 97.4% (93.4–99.1%), 21.3% (17.8–25.1%), 31.5% (27.7–35.4%), and 95.6% (90.1–98.6%), to diagnose RRF. In patients not requiring admission (n = 350), the NPV for RRF was 98.8% (93.6–100%); the negative likelihood ratio 0.08 (0.01–0.57), and sensitivity remained at 97.8% (82.2–99.9%). Applying it would have avoided performing 85/350 urgent cranial-CT (24.29%). To find one RRF, we would have gone from performing 7.8 (350/45) to 5.9 (265/45) CTs, failing to diagnose 1/45 (2.2%) RRF. Conclusions: This proposed clinical scale could potentially decrease 24% of urgent cranial-CT.
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dc.format.extent9
dc.identifier.citationEmerg Radiol 31, 835–843 (2024)
dc.identifier.doihttps://doi.org/10.1007/s10140-024-02274-6
dc.identifier.eissn1438-1435
dc.identifier.issn1070-3004
dc.identifier.urihttp://hdl.handle.net/10201/227401
dc.languageeng
dc.publisherSpringer
dc.relationSin financiación externa a la Universidad
dc.relation.ispartofParts of the work have been presented in the European Congress of Radiology on March 1–5, 2023, and on 28 February—3 March, 2024, in Vienna, Austria.
dc.relation.publisherversionhttps://link.springer.com/article/10.1007/s10140-024-02274-6
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.accessRightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectNeurology
dc.subjectDiagnosis
dc.subjectGuidelines
dc.subjectEmergency department
dc.subjectMultidetector Computed Tomography
dc.subject.odsNo relacionado con ningún objetivo de desarrollo sostenible
dc.titleClinical prediction scale approach derived from a retrospective study to reduce the number of urgent, low-value cranial CT scans
dc.typeinfo:eu-repo/semantics/article
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dspace.entity.typePublicationes
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relation.isAuthorOfPublicationc8cd3e8f-f1fd-4355-aa95-0f5dfd418f19
relation.isAuthorOfPublication5807a0de-a86a-4d76-b711-85b255177b94
relation.isAuthorOfPublication.latestForDiscoverydbc036f9-e429-4373-a198-0082097acf67
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