Head computed tomography in medical intensive care unit patients: Clinical indications
作者:
Albert Rafanan,
Pallavi Kakulavar,
John Perl,
John Andrefsky,
David Nelson,
Alejandro Arroliga,
期刊:
Critical Care Medicine
(OVID Available online 2000)
卷期:
Volume 28,
issue 5
页码: 1306-1309
ISSN:0090-3493
年代: 2000
出版商: OVID
关键词: tomography, computed radiography;intensive care unit;neurologic examination;decision making;brain;odds ratio;predictive value of tests;seizures;brain injuries/radiography;brain injuries/diagnosis;human;retrospective studies;sensitivity and specificity
数据来源: OVID
摘要:
Objective:To assess whether clinical variables might be useful in selecting patients who will have an acute intracranial abnormality seen in head computed tomographic scans (HCT).Design:Retrospective study.Setting:Medical intensive care unit (MICU) in a tertiary teaching hospital.Measurements:Medical records of patients admitted to the MICU who underwent HCT between January 1, 1994, and December 31, 1995, were reviewed. Patients with acute intracranial abnormalities (HCT-positive) and those without new acute findings (HCT-negative) were compared on various clinical variables, including demographics, indications for obtaining the HCT (mental status change, neurologic deficit, fever, seizures), coagulation profiles, when the HCT was performed (at admission or after admission), and ordering physician.Main Results:Of 297 HCTs obtained in 230 patients, 37% (109/297) were positive. When the clinical variables were examined univariately, only the presence of a neurologic deficit (70% vs. 37%; difference, 33%;p< .001) differed significantly between positive and negative HCTs. Multivariate analysis confirmed that only the frequency of a new neurologic deficit differed significantly in the two groups (p< .001; odds ratio, 3.9; 95% confidence interval, 2.3-6.4). In patients without neurologic deficits, only the presence of seizures was associated with a positive HCT (p< .01: logistic regression). The presence of either neurologic deficit or seizures best predicted a positive HCT: sensitivity 0.81, specificity 0.53, positive predictive value 0.50, and negative predictive value 0.83.Conclusion:Among MICU patients, the presence of either neurologic deficit or seizures is associated with the presence of an acute intracranial abnormality seen in HCT, but the association is not powerful enough to reliably depend on these clinical variables to select patients for HCTs in the MICU.
返 回