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.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive and Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Clinical diagnosis	+ 0 -	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

Negative Findings
Finding	Result	Sensitivity	Specificity
[ + ] History of Head Trauma	+ 0 -	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

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Papilledema	+ 0 -	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	+ 0 -	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	+ 0 -	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	+ 0 -	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	+ 0 -	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

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Papilledema	+ 0 -	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	+ 0 -	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	+ 0 -	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	+ 0 -	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	+ 0 -	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