Research Article

Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis

Table 3

Test characteristics of history and physical examination findings in relation to clinically abnormal head CTs.

ā€‰ SensitivityCISpecificityCINPVCIPPVCI

Blunt head injury139/30747.7(32.5, 63.3)55.1(48.9, 61.3)86.3(80.2, 91.1)15.1(9.6, 22.5)
Dangerous mechanism105/28533.3(19.6, 49.6)62.6(56.1, 68.7)84.4(78.3, 89.4)13.3(7.5, 21.4)
Vomiting23/3188.9(2.5, 21.2)93(89.4, 95.8)86.1(81.6, 89.3)17.4(5.0, 38.7)
Coagulopathy36/2808.3(1.8, 22.5)86.5(81.5, 90.5)86.5(81.5, 90.5)8.3(1.8, 22.5)
Skull fracture21/31911.6(3.8, 24.6)94.2(90.7, 96.64)86.9(82.6, 90.5)23.8(8.2, 47.2)
Scalp hematoma81/31926(14.2, 41.1)74.7(69.1, 79.8)85.7(80.6, 89.9)14.8(7.9, 24.5)
Neuro deficit102/31368.9(53.4, 81.8)73.5(67.8, 78.7)93.4(89.1, 96.3)30.4(21.7, 40.3)
ALOC134/31667.4(52.0, 80.5)61.9(55.8, 67.7)91.8(86.8, 95.3)23.1(16.3, 31.2)
Abnormal behavior100/31453.3(37.9, 68.3)71.8(66.0, 77.1)90.2(85.4, 93.8)24(16.0, 33.6)
No spontaneous eye opening61/31634.1(20.5, 49.9)83.1(78.1, 87.3)88.6(88.1, 92.3)24.6(14.5, 37.3)
Not oriented 189/30565.1(49.1, 79.0)66.4(60.3, 72.1)92.1(87.3, 95.5)24.1(16.7, 33.0)
Not following commands76/31043.2(28.34, 59.0)78.6(73.2, 83.4)89.3(84.6, 93.0)25(15.8, 36.3)
Amnestic28/22418.5(6.3, 38.1)88.3(83.0, 92.5)88.8(83.5, 92.8)17.9(6.1, 36.9)
Combined criteria271/32295.7(85.5, 99.5)17.8(13.5, 22.9)96.1(86.5, 99.5)16.6(12.4, 21.6)
Abnormal neuro exam207/32187(73.7, 95.1)39.3(33.5, 45.3)94.7(88.9, 98.0)19.3(14.2, 25.4)
Abnl neuro exam or vomiting217/32187(73.7, 95.1)36(30.3, 42.0)94.3(88.0, 97.9)18.5(13.6, 24.4)

: number, CI: confidence interval, PPV: positive predictive value, NPV: negative predictive value, Abnl: abnormal, and Neuro: neurological.