Neuroimaging for individuals with recurrent seizures was safely reduced in 2021 with the release of the LIMIT clinical decision instrument (CDI). The LIMIT CDI lowered neuroimaging by 13.3% and had a sensitivity of 90% and a negative predictive value of >99.9%. However, the original LIMIT CDI was difficult to use because of its design. Therefore, for a study, researchers sought to evaluate the LIMIT-NeuroImaging (LIMIT-NI) CDI’s performance in comparison to the original LIMIT CDI and to validate it.

The research involved individuals who presented to 3 emergency rooms with recurrent seizures. To all patients, the LIMIT-NI CDI was applied. In addition, they computed the LIMIT-NI CDI’s test features and contrasted them with unstructured clinical judgment.

Over 2,125 of the 3,401 patients who passed the final analysis were tested. Sixteen patients (0.75%) had positive CT results; all 16 patients were recognized with 100% sensitivity and 100% negative predictive value by the LIMIT-NI CDI and clinical judgment. Emergency care clinicians requested 835 brain CT scans using unstructured clinical judgment, compared to 499 scans if the CDI had been used. It was a reduction of 15.8% (relative reduction of 40.2%).

Comparing the LIMIT-NI CDI to the original LIMIT CDI, the LIMIT-NI CDI showed superior test characteristics and greater simplicity of application. The LIMIT-NI CDI reduced neuroimaging by 15.8% (relative reduction of 40.2%) in individuals with recurrent seizures compared to unstructured clinical judgment. Physicians can use the LIMIT-NI CDI in conjunction with their clinical judgment to limit neuroimaging in patients with recurrent seizures.

Reference: sciencedirect.com/science/article/pii/S0735675722006027