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. 2015 Aug;136(2):e351–e360. doi: 10.1542/peds.2014-3550

TABLE 4.

Risk of Clinically Relevant Intracranial Abnormalities Based on Physical Examination Findings

Criterion Risk of Abnormality if Physical Exam Finding Present,a n/N (%) Risk of Abnormality if Physical Exam Finding Absent,a n/N (%) RR (95% CI) Missing Response of “Unsure,” “Don’t Know,” “Preverbal,” “Nonverbal,” or “Not Done”
General physical examination
 Concerning skin findings (eg, café au lait) 2/7 (28.6) 38/347 (11.0) 2.6 (0.8–8.7) 0 0
Neurologic examinationb
 Abnormal mental statusc 10/62 (16.1) 25/266 (9.4) 1.7 (0.9–3.4) 3 8
 Abnormal overall neurologic exam other than mental status 7/33 (21.2) 26/291 (8.9) 2.4 (1.2–5.0)** 2 13
  Any focal neurologic findings on exam (includes examination of pupil size, cranial nerves motor tone, motor strength, reflexes) 5/16 (31.2) 30/320 (9.4) 3.3 (1.5–7.4)* 3 0
 Abnormal muscle tone (focal or diffuse) 5/18 (27.8) 30/317 (9.5) 3.3 (1.3–6.7)* 2 2
 Abnormal motor strength (focal or diffuse) 4/17 (23.5) 28/307 (9.1) 2.6 (1.0–6.5) 2 13
 Abnormal sensation (focal or bilateral) 0/3 22/246 (8.9) 0 3 87
 Abnormal reflexes (focal or bilateral) 1/11 (9.1) 26/281 (9.3) 1.0 (0.1–6.6) 7 40
 Abnormal gait 0/7 13/195 (6.7) 0 6 131
 Abnormal cranial nerves (focal or bilateral) 1/4 (25.0) 28/290 (9.7) 2.6 (0.5–14.7) 4 41
 Unequal pupil size 2/5 (40.0) 33/328 (10.1) 4.0 (1.3–12.2) 4 2
 Abnormal posturing 1/3 (33.3) 28/314 (8.9) 3.7 (0.7–19.2) 19 3
 Abnormal cerebellar functiond 0/2 11/184 (6.0) 0 1 42
 Abnormal speechd 0/6 14/196 (7.1) 0 1 26

N = 354. *P < .05, **P = .05–0.10 (χ2 analysis). RR, relative risk.

a

Denominators exclude patients for whom a data point was missing or marked as “unsure,” “don’t know,” “preverbal,” “nonverbal,” or “unable to assess.”

b

Excludes 15 patients who were sedated, paralyzed, or intubated at the time of examination.

c

Mental status for the 328 patients with known mental status was collected as follows: 266 (81.1%) with normal mental status, 45 (13.7%) with mildly impaired mental status, and 17 (5.2%) with moderately/severely impaired mental status.

d

A priori excludes from all analysis patients either younger than 24 months or those sedated, paralyzed, or intubated at the time of examination (n = 125).