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Clinical Prediction Rules for Computed Tomographic Scanning in Senile Dementia

Clinical Prediction Rules for Computed Tomographic Scanning in Senile Dementia Abstract • The role of computed tomography (CT) of the head in evaluating patients with dementing illnesses remains a controversial issue. Several prediction rules to guide the selective application of CT in the evaluation of dementia have recently been proposed in the medical literature. The present authors examine the value of four such rules through a validation study performed in an outpatient geriatric assessment unit. The rules were assessed in terms of their diagnostic sensitivities, specificities, misclassification rates, and information contents. Prediction rule sensitivities ranged from 12.5% to 87.5%, specificities from 37.2% to 77.9%, and misclassification rates from 23.5% to 60.8%. Of the four prediction rules examined, one emerged as significantly more sensitive than the others, and also served to reduce diagnostic uncertainty a full order of magnitude more than the others, as determined by an information content analysis. Disadvantages to this rule, however, were found in its more complex nature and the assessment of a very high rate of misclassification. Through a critique of existing strategies, this study purports to determine the potential for establishing a useful clinical prediction rule to guide selective CT scanning in the diagnostic evaluation of dementia. (Arch Intern Med 1987;147:77-80) References 1. Marsden CD, Harrison MJG: Outcome of investigation of patients with presenile dementia. Br Med J 1972;2:249-252.Crossref 2. Smith JS, Kiloh LG: The investigation of dementia: Results of 200 consecutive admissions. Lancet 1981;1:821-827. 3. Smith JS, Kiloh LG, Ratnavale GL, et al: The investigation of dementia: The results in 100 consecutive admissions. Med J Aust 1976;2: 403-405. 4. Wells CE: Diagnostic evaluation and treatment in dementia , in Wells CE (ed): Dementia , ed 2. Philadelphia, FA Davis Co Publishers, 1977, pp 247-276. 5. Loty PR: Neurologic disorders: The many new uses of CT. Geriatrics 1985;40:40-53. 6. National Institute on Aging Task Force: Senility reconsidered: Treatment possibilities for mental impairment in the elderly. JAMA 1980;244: 259-263.Crossref 7. Bradshaw JR, Thomas JLB, Campbell MJ: Computed tomography in the investigation of dementia. Br Med J 1983;286:277-280.Crossref 8. Larson EB: New technology in radiology: Better may mean less. AJR 1982;136:838-839.Crossref 9. Dietch JT: Computerized tomographic scanning in cases of dementia. West J Med 1983;138:835-387. 10. Larson EB, Reiffer BV, Featherstone JH, et al: Dementia in elderly outpatients: A prospective study. Ann Intern Med 1984;100:417-423.Crossref 11. Larson EB, Reiffer BV, Canfield C, et al: Evaluating elderly outpa- 12. tients with symptoms of dementia. Hosp Community Psychiatry 1984; 35:425-428. 13. Beresford TP, Blow FC, Nichols LO, et al: Focal signs and brain CT scans in psychiatric patients. N Engl J Med 1985;313:388. 14. Martin DC, Morycz RK, McDowell BJ, et al: Community-based geriatric assessment. J Am Geriatr Soc 1985;33:602-606. 15. Duke University Center for the Study of Aging and Human Development: Multidimensional Functional Assessment: The OARS methodology . Durham, NC, 1978. 16. Folstein M, Folstein S, McHugh P: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.Crossref 17. Rosen WG, Terry RD, Fuld PA, et al: Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980;7:486-488.Crossref 18. Metz CE, Goodenough DJ, Rossmann K: Evaluation of receiver operating characteristic curve data in terms of information theory, with applications in radiography. Radiology 1973;109:297-303.Crossref 19. Eisdorfer C, Cohen D: Diagnostic criteria for primary neuronal degeneration of the Alzheimer's type. J Fam Pract 1980;1:553-557. 20. Glatt SL, Lantos G, Danziger A, et al: Efficacy of CT in the diagnosis of vascular dementia. J Neurosci Res 1983;4:703-705. 21. Wasson JH, Sox HC, Neff RK, et al: Clinical prediction rules: Applications and methodological standards. N Engl J Med 1985;313: 793-799.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical Prediction Rules for Computed Tomographic Scanning in Senile Dementia

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References (24)

Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1987.00370010081020
Publisher site
See Article on Publisher Site

Abstract

Abstract • The role of computed tomography (CT) of the head in evaluating patients with dementing illnesses remains a controversial issue. Several prediction rules to guide the selective application of CT in the evaluation of dementia have recently been proposed in the medical literature. The present authors examine the value of four such rules through a validation study performed in an outpatient geriatric assessment unit. The rules were assessed in terms of their diagnostic sensitivities, specificities, misclassification rates, and information contents. Prediction rule sensitivities ranged from 12.5% to 87.5%, specificities from 37.2% to 77.9%, and misclassification rates from 23.5% to 60.8%. Of the four prediction rules examined, one emerged as significantly more sensitive than the others, and also served to reduce diagnostic uncertainty a full order of magnitude more than the others, as determined by an information content analysis. Disadvantages to this rule, however, were found in its more complex nature and the assessment of a very high rate of misclassification. Through a critique of existing strategies, this study purports to determine the potential for establishing a useful clinical prediction rule to guide selective CT scanning in the diagnostic evaluation of dementia. (Arch Intern Med 1987;147:77-80) References 1. Marsden CD, Harrison MJG: Outcome of investigation of patients with presenile dementia. Br Med J 1972;2:249-252.Crossref 2. Smith JS, Kiloh LG: The investigation of dementia: Results of 200 consecutive admissions. Lancet 1981;1:821-827. 3. Smith JS, Kiloh LG, Ratnavale GL, et al: The investigation of dementia: The results in 100 consecutive admissions. Med J Aust 1976;2: 403-405. 4. Wells CE: Diagnostic evaluation and treatment in dementia , in Wells CE (ed): Dementia , ed 2. Philadelphia, FA Davis Co Publishers, 1977, pp 247-276. 5. Loty PR: Neurologic disorders: The many new uses of CT. Geriatrics 1985;40:40-53. 6. National Institute on Aging Task Force: Senility reconsidered: Treatment possibilities for mental impairment in the elderly. JAMA 1980;244: 259-263.Crossref 7. Bradshaw JR, Thomas JLB, Campbell MJ: Computed tomography in the investigation of dementia. Br Med J 1983;286:277-280.Crossref 8. Larson EB: New technology in radiology: Better may mean less. AJR 1982;136:838-839.Crossref 9. Dietch JT: Computerized tomographic scanning in cases of dementia. West J Med 1983;138:835-387. 10. Larson EB, Reiffer BV, Featherstone JH, et al: Dementia in elderly outpatients: A prospective study. Ann Intern Med 1984;100:417-423.Crossref 11. Larson EB, Reiffer BV, Canfield C, et al: Evaluating elderly outpa- 12. tients with symptoms of dementia. Hosp Community Psychiatry 1984; 35:425-428. 13. Beresford TP, Blow FC, Nichols LO, et al: Focal signs and brain CT scans in psychiatric patients. N Engl J Med 1985;313:388. 14. Martin DC, Morycz RK, McDowell BJ, et al: Community-based geriatric assessment. J Am Geriatr Soc 1985;33:602-606. 15. Duke University Center for the Study of Aging and Human Development: Multidimensional Functional Assessment: The OARS methodology . Durham, NC, 1978. 16. Folstein M, Folstein S, McHugh P: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.Crossref 17. Rosen WG, Terry RD, Fuld PA, et al: Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980;7:486-488.Crossref 18. Metz CE, Goodenough DJ, Rossmann K: Evaluation of receiver operating characteristic curve data in terms of information theory, with applications in radiography. Radiology 1973;109:297-303.Crossref 19. Eisdorfer C, Cohen D: Diagnostic criteria for primary neuronal degeneration of the Alzheimer's type. J Fam Pract 1980;1:553-557. 20. Glatt SL, Lantos G, Danziger A, et al: Efficacy of CT in the diagnosis of vascular dementia. J Neurosci Res 1983;4:703-705. 21. Wasson JH, Sox HC, Neff RK, et al: Clinical prediction rules: Applications and methodological standards. N Engl J Med 1985;313: 793-799.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1987

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