Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis
Background. It is unclear whether history and physical examination findings can predict abnormalities on head computed tomography (CT) believed to indicate increased risk of lumbar-puncture- (LP-) induced brain herniation. The objectives of this study were to (1) identify head CT findings felt to be...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2013/314948 |
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| author | Kelli N. O'Laughlin Jerome R. Hoffman Steven Go Gelareh Z. Gabayan Erum Iqbal Guy Merchant Roberto A. Lopez-Freeman Michael I. Zucker William R. Mower |
| author_facet | Kelli N. O'Laughlin Jerome R. Hoffman Steven Go Gelareh Z. Gabayan Erum Iqbal Guy Merchant Roberto A. Lopez-Freeman Michael I. Zucker William R. Mower |
| author_sort | Kelli N. O'Laughlin |
| collection | DOAJ |
| description | Background. It is unclear whether history and physical examination findings can predict abnormalities on head computed tomography (CT) believed to indicate increased risk of lumbar-puncture- (LP-) induced brain herniation. The objectives of this study were to (1) identify head CT findings felt to be associated with increased risk of brain herniation and (2) to assess the ability of history and physical examination to predict those findings. Methods. Using a modified Delphi survey technique, an expert panel defined CT abnormalities felt to predict increased risk of LP-induced brain herniation. Presence of such findings on CT was compared with history and physical examination (H&P) variables in 47 patients. Results. No H&P variable predicted “high-risk” CT; combining H&P variables to improve sensitivity led to extremely low specificity and still failed to identify all patients with high-risk CT. Conclusions. “High-risk” CT is not uncommon in patients with clinical characteristics known to predict an absence of actual risk from LP, and thus it may not be clinically relevant. “Overdiagnosis” will be increasingly problematic as technological advances identify increasingly subtle deviations from “normal.” |
| format | Article |
| id | doaj-art-7d7c3bfd208948e09335ab585d8fe264 |
| institution | Kabale University |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-7d7c3bfd208948e09335ab585d8fe2642025-02-03T05:58:09ZengWileyEmergency Medicine International2090-28402090-28592013-01-01201310.1155/2013/314948314948Nonconcordance between Clinical and Head CT Findings: The Specter of OverdiagnosisKelli N. O'Laughlin0Jerome R. Hoffman1Steven Go2Gelareh Z. Gabayan3Erum Iqbal4Guy Merchant5Roberto A. Lopez-Freeman6Michael I. Zucker7William R. Mower8Department of Emergency Medicine, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115, USAUniversity of California, Los Angeles (UCLA) David Geffen School of Medicine, 10833 Le Conte Avenue No. 12138, Los Angeles, CA 90095, USADepartment of Emergency Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USAGreater Los Angeles Veterans Affairs Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USASchool of Medicine, University of California, Irvine, 1001 Health Sciences Road, 252 Irvine Hall, Irvine, CA 92697-3950, USAUCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, USADepartment of Emergency Medicine, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219, USAUniversity of California, Los Angeles (UCLA) David Geffen School of Medicine, 10833 Le Conte Avenue No. 12138, Los Angeles, CA 90095, USAUniversity of California, Los Angeles (UCLA) David Geffen School of Medicine, 10833 Le Conte Avenue No. 12138, Los Angeles, CA 90095, USABackground. It is unclear whether history and physical examination findings can predict abnormalities on head computed tomography (CT) believed to indicate increased risk of lumbar-puncture- (LP-) induced brain herniation. The objectives of this study were to (1) identify head CT findings felt to be associated with increased risk of brain herniation and (2) to assess the ability of history and physical examination to predict those findings. Methods. Using a modified Delphi survey technique, an expert panel defined CT abnormalities felt to predict increased risk of LP-induced brain herniation. Presence of such findings on CT was compared with history and physical examination (H&P) variables in 47 patients. Results. No H&P variable predicted “high-risk” CT; combining H&P variables to improve sensitivity led to extremely low specificity and still failed to identify all patients with high-risk CT. Conclusions. “High-risk” CT is not uncommon in patients with clinical characteristics known to predict an absence of actual risk from LP, and thus it may not be clinically relevant. “Overdiagnosis” will be increasingly problematic as technological advances identify increasingly subtle deviations from “normal.”http://dx.doi.org/10.1155/2013/314948 |
| spellingShingle | Kelli N. O'Laughlin Jerome R. Hoffman Steven Go Gelareh Z. Gabayan Erum Iqbal Guy Merchant Roberto A. Lopez-Freeman Michael I. Zucker William R. Mower Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis Emergency Medicine International |
| title | Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis |
| title_full | Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis |
| title_fullStr | Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis |
| title_full_unstemmed | Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis |
| title_short | Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis |
| title_sort | nonconcordance between clinical and head ct findings the specter of overdiagnosis |
| url | http://dx.doi.org/10.1155/2013/314948 |
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