The following is the summary of “The LIMIT-NI clinical decision instrument reduces neuroimaging compared to unstructured clinician judgment in recurrent seizure patients,” published in the December 2022 issue of Emergency medicine by Isenberg, et al.

In 2021, doctors published the LIMIT clinical decision instrument (CDI) to help limit neuroimaging risks for patients with recurrent seizures. Sensitivity was 90%, negative predictive value was (>99.9%), and neuroimaging was reduced by 13% according to the LIMIT CDI. While the original LIMIT CDI had great potential, its architecture ultimately limited its usefulness. The purpose of this research was to verify that the condensed LIMIT-NeuroImaging (LIMIT-NI) CDI is as effective as the original version.

Patients with recurrent seizures who presented to three different ERs were the focus of this observational study. All patients were administered the LIMIT-NI CDI. The LIMIT-NI CDI’s assessment characteristics were determined and compared to unstructured clinical judgement. Out of the initial pool of 3,401 patients, 2,125 met the criteria for inclusion. The LIMIT-NI CDI and clinician judgment both correctly identified all 16 patients with a sensitivity of 100% and a negative predictive value of 100% who had positive CTs (0.75%). Providers in emergency rooms ordered 835 brain CTs using unstructured clinical judgement, while only 499 brain CTs would have been requested had they used the CDI, a reduction of 15.8% (relative reduction 40.2%).

Compared to the classic LIMIT CDI, the LIMIT-NI CDI proved superior in terms of its ease of use and test properties. By using the LIMIT-NI CDI, neuroimaging in patients with recurrent seizures was reduced by 15.8% (relative reduction 40.2% vs. unstructured physician judgment). Neuroimaging in patients with recurrent seizures can be reduced with the use of the LIMIT-NI CDI and the doctor’s clinical judgment.

Source: sciencedirect.com/science/article/abs/pii/S0735675722006027