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Clinical criteria to exclude acute vascular pathology on CT angiogram in patients with dizziness

Long H Tu1, Ajay Malhotra1, Arjun K Venkatesh2

  • 1Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America.

Plos One
|March 9, 2023
PubMed

Insights

A new clinical decision rule can identify dizzy patients with a near-zero risk of acute vascular pathology on CT angiography (CTA) head and neck scans. This may help avoid unnecessary imaging in up to 52% of emergency department cases.

Area of Science:

  • Emergency Medicine
  • Neurology
  • Radiology

Background:

  • Dizziness is a common emergency department (ED) complaint.
  • CT angiography (CTA) of the head and neck is used to detect acute vascular pathology, such as large vessel occlusion.
  • Identifying patients with dizziness who have a low risk of acute vascular abnormality is crucial.

Purpose of the Study:

  • To derive and validate a clinical decision rule to identify emergency department patients with dizziness who are at very low risk for acute vascular pathology on CTA head and neck.
  • To assess the potential to reduce CTA utilization in dizzy patients.

Main Methods:

  • A cross-sectional analysis of adult ED encounters with dizziness and CTA head and neck imaging was performed.
  • A decision rule was derived and tested on separate validation and sensitivity analysis cohorts.
  • Sensitivity, specificity, and negative predictive value were calculated.

Main Results:

  • The derived decision rule demonstrated 100% sensitivity and 100% negative predictive value in both derivation and validation phases.
  • The rule identified that up to 52% of dizziness CTA scans might be avoidable.
  • The rule performed similarly on "stroke code" presentations and outperformed NIHSS cut-offs.

Conclusions:

  • A clinical decision rule based on specific patient factors can effectively exclude acute vascular pathology in dizzy patients.
  • This rule could potentially reduce the need for CTA head and neck imaging in a significant proportion of ED visits for dizziness.
  • Further prospective validation is needed to implement this rule in clinical practice.
Abstract

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