Isenberg et al reported a clinical decision instrument for performance of an emergency brain CT on a patient with status epilepticus. Careful selection of patients can reduce the number of unnecessary studies. The authors are from Temple University in Philadelphia.

Patient selection: status epilepticus, age >= 18 years


High-risk conditions:

(1) history of intracranial hemorrhage

(2) malignancy

(3) immunosuppression (AIDS, chronic corticosteroids, biologic agents)

(4) head trauma


Patients receiving anticoagulants who had an acute finding on brain CT had one or more of the high-risk conditions.


Positive findings on CT include:

(1) hemorrhage or hematoma

(2) intracranial contusion

(3) cerebral edema

(4) anoxia

(5) new ischemic changes

(6) herniation or midline shift

(7) new hydrocephalus



The sensitivity was 88% and specificity 87%.

The negative predictive value was 99.5%.

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