{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T23:12:51Z","timestamp":1770505971477,"version":"3.49.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"965","license":[{"start":{"date-parts":[[2006,3,1]],"date-time":"2006-03-01T00:00:00Z","timestamp":1141171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>It is becoming increasingly common to request computed tomography (CT) to rule out space occupying lesions before lumbar puncture (LP), even in patients with no clinical signs. Imaging trends within a busy district general hospital in Oxfordshire, UK were analysed with results used to clarify when imaging should be considered mandatory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>A retrospective six month sample was obtained comprising all adults considered for LP. Observed frequencies of abnormal examination findings compared with abnormal investigations were used to determine sensitivity, specificity, positive predictive, and negative predictive values to assess the validity of using a normal clinical examination as a basis for excluding CT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>64 patients were considered for LP. In total, 58 patients underwent LP, with a single patient receiving two. After an abnormal CT scan, six patients did not undergo a planned LP. In all six of these cases subarachnoid haemorrhage was detected, and in all cases this was considered a probable diagnosis. In no case was an LP precluded by an unsuspected space occupying lesion. Neurological examination showed a sensitivity of 0.72 (0.52 to 0.93), specificity 0.78 (0.64 to 0.91), positive predictive value 0.61 (0.41 to 0.83), and negative predictive value 0.85 (0.73 to 0.97).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The high sensitivity and negative predictive values support normal neurological examination as an effective predictor of normal CT scan. This permits the recommendation in cases where subarachnoid haemorrhage is not suspected, a CT scan can be avoided provided there are no abnormal findings on physical or fundoscopic examination.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/pgmj.2005.041046","type":"journal-article","created":{"date-parts":[[2006,3,3]],"date-time":"2006-03-03T21:42:58Z","timestamp":1141422178000},"page":"162-165","source":"Crossref","is-referenced-by-count":17,"title":["Role of computed tomography before lumbar puncture: a survey of clinical practice"],"prefix":"10.1093","volume":"82","author":[{"given":"P R","family":"Greig","sequence":"first","affiliation":[{"name":"Horton General Hospital , Banbury, Oxfordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Goroszeniuk","sequence":"additional","affiliation":[{"name":"Horton General Hospital , Banbury, Oxfordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2006,3,3]]},"reference":[{"key":"2023042013494163400_bib1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/00004032-200307000-00011","article-title":"Cancer risks from medical irradiation","volume":"85","author":"Ron","year":"2003","journal-title":"Health Physics"},{"key":"2023042013494163400_bib2","volume-title":"Royal College of Radiologists Making the best use of a department of clinical radiology: guidance for doctors","edition":"5th ed"},{"key":"2023042013494163400_bib3","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1002\/1097-0142(19810301)47:5+<1081::AID-CNCR2820471305>3.0.CO;2-3","article-title":"Cancer following medical irradiation","volume":"47","author":"Boice","year":"1981","journal-title":"Cancer"},{"key":"2023042013494163400_bib4","first-page":"690","volume-title":"Saunders pocket essentials of clinical medicine","author":"Ballinger","year":"2004","edition":"3rd ed"},{"key":"2023042013494163400_bib5","first-page":"24","volume-title":"Oxford textbook of medicine","author":"Warrel","year":"2004","edition":"3rd ed"},{"key":"2023042013494163400_bib6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/PL00007855","article-title":"Lumbar puncture and the risk of herniation: when should we first perform CT?","volume":"249","author":"van Crevel","year":"2002","journal-title":"J Neurology"},{"key":"2023042013494163400_bib7","first-page":"844","volume-title":"Oxford handbook of acute medicine","author":"Ramrakha","year":"2003","edition":"1st ed"},{"key":"2023042013494163400_bib8","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1080\/02688690310001627858","article-title":"The investigation of acute severe headache suggestive of probable subarachnoid haemorrhage\u2013a hospital based study","volume":"17","author":"Webb","year":"2003","journal-title":"Br J Neurosurg"},{"key":"2023042013494163400_bib9","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1056\/NEJMoa010399","article-title":"Computed tomography of the head before lumbar puncture in adults with suspected meningitis","volume":"345","author":"Hasbun","year":"2001","journal-title":"NEJM"},{"key":"2023042013494163400_bib10","doi-asserted-by":"crossref","first-page":"2681","DOI":"10.1001\/archinte.159.22.2681","article-title":"Cranial computed tomography before lumbar puncture","volume":"159","author":"Gopal","year":"1999","journal-title":"Arch Intern Med"},{"key":"2023042013494163400_bib11","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1001\/archinte.162.16.1904","article-title":"Subdural haematoma following lumbar puncture","volume":"162","author":"Guacher","year":"2002","journal-title":"Arch Intern Med"},{"key":"2023042013494163400_bib12","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S0303-8467(03)00040-4","article-title":"Iatrogenic spinal epidermoid tumour. A complication of spinal puncture in an adult","volume":"105","author":"Park","year":"2003","journal-title":"Clin Neurol Neurosurg"},{"key":"2023042013494163400_bib13","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1093\/brain\/124.2.249","article-title":"Subarachnoid haemorrhage: diagnosis, causes and management","volume":"124","author":"van Gijn","year":"2001","journal-title":"Brain"},{"key":"2023042013494163400_bib14","volume-title":"Basic epidemiology","author":"Beaglehole","year":"1993"},{"key":"2023042013494163400_bib15","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1136\/bmj.324.7335.477","article-title":"Evidence base of clinical diagnosis: evaluation of diagnostic procedures","volume":"324","author":"Knottnerus","year":"2002","journal-title":"BMJ"},{"key":"2023042013494163400_bib16","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1111\/j.1553-2712.1997.tb03756.x","article-title":"Cranial computed tomography in the emergency evaluation of adults without a history of recent head trauma: a prospective analysis","volume":"4","author":"Rothrock","year":"1997","journal-title":"Acad Emerg Med"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/82\/965\/162\/50024650\/postgradmedj-82-162.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/82\/965\/162\/50024650\/postgradmedj-82-162.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T17:01:24Z","timestamp":1682010084000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/82\/965\/162\/7045180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,3,1]]},"references-count":16,"journal-issue":{"issue":"965","published-online":{"date-parts":[[2006,3,3]]},"published-print":{"date-parts":[[2006,3,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.2005.041046","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2006,3]]},"published":{"date-parts":[[2006,3,1]]}}}