88 Does CTA increase overdiagnosis through incidental findings in comparison to plain CT?
Notice bibliographique
Résumé
<h3>Introduction</h3> Incidental findings are those which are not clinically significant for the patient but have the potential to cause worry and stress for the patient, as well as additional strain on the healthcare system through unnecessary (and potentially harmful) downstream testing and intervention. The effect of incidental findings is important to consider in the workup of patients with suspected acute ischemic stroke (AIS) and transient ischemic attack (TIA) since up to 30% of these cases are ultimately found to be non-ischemic mimics.<sup>1</sup> Various forms of computed tomography (CT) are available for initial investigation of AIS and TIA. These modalities include non-contrast CT (NCCT), CT angiography head and neck (CTA), and CT perfusion (CTP). When choosing between modalities, physicians need to balance the need to accurately diagnose AIS/TIA against the potential for incidental findings on imaging. <h3>Objectives</h3> The primary objective was to characterize the balance between diagnostic yield and incidental findings between different neuroimaging strategies among patients presenting to urban academic emergency departments (ED)s with symptoms of AIS or TIA undergoing investigation. <h3>Methods</h3> In this cross-sectional study, we analyzed anonymized records for patients presenting to adult EDs in 2019 with a triage complaint of suspected stroke or TIA. Diagnostic imaging (DI) modalities were recorded, including non-contrast computed tomography (NCCT) and CT angiography (CTA). Other modalities were excluded from analysis because the number of these scans within our sample size was too few. DI reports were reviewed and coded into 3 categories based on a prespecified list of expert-consensus clinically significant neuroimaging Findings 1) significant findings (requiring immediate or urgent follow-up clinical action), 2) incidental findings (not meeting criteria for clinical significance), and 3) no abnormalities. The diagnostic yield was defined as the percentage of scans which produced significant findings. Standard descriptive statistics were performed. A two-sided p-value of 0.05 was considered significant. <h3>Results</h3> Among 551 included patients, 20% received NCCT alone and 80% received combined NCCT+CTA imaging. The diagnostic yield of NCCT alone for clinically significant findings was 6% compared to 24% in those who received NCCT+CTA (p<0.01). The proportion of incidental findings was non-significantly higher in the combined NCCT+CTA group as compared to the NCCT only group (36% vs 28% respectively, p=0.10). <h3>Conclusions</h3> In this study of patients presenting with suspected stroke or TIA, an NCCT+CTA neuroimaging strategy demonstrated a higher diagnostic yield than NCCT alone with an associated non-significantly increased proportion of incidental findings. This data can inform decision-making around neuroimaging in suspected AIS and TIA. <h3>Reference</h3> Hand P, Kwan J, Lindley R, <i>et al</i>. Distinguishing between stroke and mimic at the bedside: the brain attack study. <i>Stroke</i> 2006;<b>37</b>:769–775.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».