caa a22 4500 606171878 CHVBK 20210128100725.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s10140-015-1305-x doi (NATIONALLICENCE)springer-10.1007/s10140-015-1305-x Clinical scoring system may improve yield of head CT of non-trauma emergency department patients [Elektronische Daten] [Christopher Bent, Paul Lee, Peter Shen, Heejung Bang, Mathew Bobinski] The positive rate of head CT in non-trauma patients presenting to the emergency department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and three derived algorithms. Positive CTs were found in 51 of 500 patients (10.2%). Only two clinical factors were significant: focal neurologic deficit (adjusted odds ratio (OR) 20.7; 95% confidence interval (CI) 9.4-45.7) and age >55 (adjusted OR 3.08; CI 1.44-6.56). Area under the ROC curve for all three algorithms was 0.73-0.83. In proposed algorithm C, only patients with focal neurologic deficit (major risk factor) or ≥2 of the five minor risk factors (altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age) would undergo CT imaging. This may reduce utilization by 34% with only a small decrease in sensitivity (98%). Our simple scoring algorithm utilizing multiple clinical risk factors could help to predict the non-trauma patients who will benefit from CT imaging, resulting in reduced radiation exposure without sacrificing sensitivity. American Society of Emergency Radiology, 2015 Computed tomography (CT) nationallicence Emergency department (ED) nationallicence Utilization nationallicence Actionable results nationallicence Clinical risk factors nationallicence OR : Odds ratio nationallicence AUC : Area under curve nationallicence CT : Computed tomography nationallicence ED : Emergency department nationallicence EMR : Electronic medical records nationallicence PRES : Posterior reversible encephalopathy syndrome nationallicence Bent Christopher Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut Lee Paul Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut Shen Peter Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut Bang Heejung Department of Public Health Sciences, Division of Biostatistics, University of California, Davis School of Medicine, Sacramento, CA, USA aut Bobinski Mathew Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut Emergency Radiology Springer Berlin Heidelberg 22/5(2015-10-01), 511-516 1070-3004 22:5<511 2015 22 10140 https://doi.org/10.1007/s10140-015-1305-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10140-015-1305-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bent Christopher Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut NATIONALLICENCE 700 1- Lee Paul Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut NATIONALLICENCE 700 1- Shen Peter Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut NATIONALLICENCE 700 1- Bang Heejung Department of Public Health Sciences, Division of Biostatistics, University of California, Davis School of Medicine, Sacramento, CA, USA aut NATIONALLICENCE 700 1- Bobinski Mathew Department of Diagnostic Radiology, Section of Neuroradiology, University of California, Davis School of Medicine, 4860 Y Street, Ste 3100, 95816, Sacramento, CA, USA aut NATIONALLICENCE 773 0- Emergency Radiology Springer Berlin Heidelberg 22/5(2015-10-01), 511-516 1070-3004 22:5<511 2015 22 10140