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Validation of clinical criteria for referral to head imaging in the neurologic emergency setting

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Abstract

Background

In recent decades, diagnostic imaging became an important generator of large increases in medical spending. Inappropriate head CT referrals also increase population irradiation and unnecessarily burden and frighten patients.

Objective

To validate previously proposed clinical criteria for referral to head imaging (age > 55 years, focal neurological deficit, changed mental state, nausea or vomiting, coagulation disorder, cancer) in a setting of emergency neurological service.

Methods

We retrospectively analyzed electronic records of 500 consecutive referrals to neurological emergency and 500 referrals to emergency head imaging. In patients with several referrals, only results of the first evaluation were further analyzed. We calculated relations between clinical predictors, referrals, and findings of head imaging.

Results

Of 486 first referrals of consecutive patients, 216 (44%) were referred to the emergency, and 100 (21%) to non-emergency head imaging. Remaining 170 (35%) were not referred to head imaging. Clinical predictors of pathologic head imaging fulfilled 77%, 41%, and 43% of patients, respectively. Pathologic head imaging had 153 of 490 (31%) referred patients. Referral criteria fulfilled 146 (sensitivity 95%) of them. Intracranial pathology was found in 7 of 125 patients not fulfilling referral criteria (negative predictive value 94%): 3 reported transient neurological symptoms, 2 sudden headache, and 2 headache with nausea and vomiting.

Conclusion

We confirmed utility of previously proposed clinical criteria for referral to head CT in emergency neurological setting. In addition, we found transient neurological symptoms, sudden severe headache, and headache with nausea or vomiting as additional independent indications for emergency head imaging.

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Acknowledgments

The authors thank Vanja Erčulj for the help with statistical analyses and Dr. Dianne Jones for language review.

Funding

One of the authors (SP) was supported by the Republic of Slovenia Research Agency, Grant No. P3-0338.

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Authors and Affiliations

  1. Division of Neurology, University Medical Center, SI-1525, Ljubljana, Slovenia

    Primož Žužek, Igor Rigler & Simon Podnar

Authors
  1. Primož Žužek
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  2. Igor Rigler
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  3. Simon Podnar
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Corresponding author

Correspondence to Simon Podnar.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The study was approved by the relevant research ethics committee that waived the necessity of obtaining written informed consent from patients.

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Žužek, P., Rigler, I. & Podnar, S. Validation of clinical criteria for referral to head imaging in the neurologic emergency setting. Neurol Sci 40, 2541–2548 (2019). https://doi.org/10.1007/s10072-019-04009-9

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  • DOI: https://doi.org/10.1007/s10072-019-04009-9

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