Clinical diagnostic model for cerebral infarcts in women with eclampsia; a cross-sectional study

Résumé fourni par la source

Objective Eclampsia is associated with short- and long-term neurological deficits. Identifying which women may be at risk is important. Magnetic resonance imaging shows an incidence of 30–40% of subclinical cerebral infarcts among women with eclampsia. A simple screening tool would be useful to identify at-risk women. The objective of this study was to develop a clinical prediction model to identify women at highest risk of developing cerebral infarcts in women who have experienced eclampsia. Design This was a prospective, cross-sectional study at Tygerberg Hospital, a tertiary referral center in Cape Town, South Africa. Forty-nine women with eclampsia were included. Women were prospectively assessed for symptoms and signs known to be associated with eclampsia and all women underwent brain magnetic resonance imaging. Main outcome measure was the presence of cerebral infarcts. All symptoms and signs were assessed for accuracy against the outcome. Variables significant at the 20% level were assessed in a stepwise selection for a final multivariate model. Results A total of 49 women with eclampsia were included in the analysis, of whom 33% (n=16) had cerebral infarcts. Variables included in the diagnostic model for cerebral infarcts were highest systolic blood pressure and impaired hearing. The model demonstrated an AUC of 0.72 (95% CI 0.56 to 0.88) with corresponding sensitivity of 60% (95% CI 36 to 80%) and specificity of 84% (95% CI 67 to 93%) for cerebral infarcts. Conclusions A simple clinical risk assessment has moderate accuracy for identification of cerebral infarcts in eclampsia. This risk assessment tool may be a useful triage tool to help decide which women require imaging and neurological follow up.

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