Simple clinical predictors of brain lesions in patients with impaired consciousness: a cross sectional study from a rural, tertiary hospital in central India.
OBJECTIVE
To evaluate the diagnostic accuracy of vital signs for detecting brain lesions in patients with impaired consciousness in a rural setting.


METHODS
We enrolled patients older than 12 years who presented with impaired consciousness of non-traumatic origin to the intensive care unit of a rural teaching hospital. The design was a cross sectional analysis of a hospital-based case series, independently comparing vital signs on admission (temperature, pulse, systolic and diastolic blood pressure) against a reference standard (final diagnosis). Diagnostic accuracy was measured by computing multi-level likelihood ratios, and area under the receiver operating characteristic (ROC) curve.


RESULTS
We studied 386 patients of whom 242 (62.7%) were men. A total of 178 patients (46%) had a brain lesion. None of the clinical predictors could accurately distinguish between those with and without a brain lesion. The area under the ROC curve for pulse was 0.61 (S.E. 0.02); that for the systolic and diastolic blood pressure 0.70 (S.E. 0.02) each. Systolic BP provided informative test results in 29.7%, diastolic BP in 37.2% and pulse rate in 19.9% patients.


CONCLUSIONS
Our findings suggest that the vital signs lack accuracy for ruling in or ruling out brain lesion in patients with impaired consciousness.
Geetadevi
Y
Y
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India.
Joshi
Rajnish
R
Pai
Madhukar
M
Kalantri
S P
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001831:Body Temperature; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D003244:Consciousness Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006780:Hospitals, Rural; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results