Increased Intracranial Pressure: Sensitivity and Specificity

Introduction: It is contraindicated to perform a lumbar puncture on a patient with increased intracranial pressure because of the danger of herniation. The gold standard test for elevated ICP is CT scan.

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The sensitivity and specificity of findings for Increased Intracranial Pressure are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Clinical diagnosis

100%

94.7%

i.e. based on abnormal findings on history or physical exam

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Papilledema Duplicate	12%	98.9%	by emergency medicine residents in the ED gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
History of CNS Mass	11.9%	96.8%	gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
History of Head Trauma	6%	91%	Within last 72 hours (Note: NOT DIAGNOSTIC!) gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
Focal Neurological Signs	42.3%	90.2%	gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
History of Seizure	18%	87%	Within last 72 hours gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Negative Findings

History of Head Trauma

91%

Within last 72 hours

(Note: NOT DIAGNOSTIC!)

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Poorly Diagnostic Findings

Finding	Sensitivity	Specificity	Comments, Study
Papilledema Duplicate	59.3%	84.5%	by family practitioners viewing a picture of a stereoscopic view of a dilated eye Study: J Fam Pract. 1991 Oct;33(4):381-6. PMID: 1919455
History of HIV	20%	83.3%	HIV positivity gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
Papilledema Duplicate	80.4%	82.9%	by ophthalmologists viewing a picture of a stereoscopic view of a dilated eye Study: J Fam Pract. 1991 Oct;33(4):381-6. PMID: 1919455
Immunosuppressed	47.9%	69.5%	gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
Altered Mental Status	76.5%	65.2%	gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758