Increased Intracranial Pressure: Likelihood Ratios

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 likelihood ratios of findings for Increased Intracranial Pressure are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Clinical diagnosis	18.8	0	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
Papilledema Duplicate	4.7	0.2	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
Altered Mental Status	2.2	0.4	gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
Papilledema Duplicate	3.8	0.5	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

Good Positive Likelihood Ratio

Finding	+LR	-LR	Comments, Study
Papilledema Duplicate	11.1	0.9	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
Focal Neurological Signs	4.3	0.6	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	3.7	0.9	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	+LR	-LR	Comments, Study
History of Head Trauma	0.7	1	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
History of Seizure	1.4	0.9	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
History of HIV	1.2	1	HIV positivity gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758
Immunosuppressed	1.6	0.8	gold standard is CT (? is LP contraindicated) Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758