CureusPub Date : 2025-06-26eCollection Date: 2025-06-01DOI: 10.7759/cureus.86820
Chidinma S Madu, Victoria M Ajibade
{"title":"Acute Stroke Management and Nursing Intervention.","authors":"Chidinma S Madu, Victoria M Ajibade","doi":"10.7759/cureus.86820","DOIUrl":"10.7759/cureus.86820","url":null,"abstract":"<p><p>Stroke remains a leading cause of mortality and long-term disability worldwide, necessitating prompt and effective management strategies to optimize patient outcomes. Acute stroke management involves rapid diagnosis, timely pharmacological and mechanical interventions, and coordinated multidisciplinary care. Among healthcare professionals, nurses play a pivotal role in the early identification, stabilization, and ongoing management of stroke patients, particularly during the hyperacute and acute care phases. This review article explores current evidence-based approaches in acute stroke management, including the use of thrombolytics, thrombectomy, and neuroimaging techniques, while emphasizing the critical role of nursing interventions such as neurological assessment, airway and hemodynamic support, medication administration, and patient education. Furthermore, it discusses the integration of stroke care pathways and the impact of nurse-led initiatives on patient outcomes. This review, involving recent literature, highlights the importance of collaborative, guideline-driven care and the evolving responsibilities of nurses in improving the survival and recovery of patients experiencing acute stroke.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86820"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-26eCollection Date: 2025-06-01DOI: 10.7759/cureus.86819
Tyler R Ellett, Andrew Pippas, Humberto Rios, Seema B Jabbar
{"title":"The Deadly Masquerade: Unveiling the Fatal Facade of the Great Imitator.","authors":"Tyler R Ellett, Andrew Pippas, Humberto Rios, Seema B Jabbar","doi":"10.7759/cureus.86819","DOIUrl":"10.7759/cureus.86819","url":null,"abstract":"<p><p>Sclerosing cholangitis (SC) is a fibroinflammatory condition that results in the progressive narrowing and destruction of bile ducts. It is generally classified into three distinct types: primary sclerosing cholangitis (PSC), secondary cholangitis, and immunoglobulin G4 (IgG4)-related cholangitis (IRC). IgG4-sclerosing cholangitis (IgG4-SC) is a rare entity characterized by inflammation and strictures within the biliary tree, arising from host-mediated immune responses. This condition represents the biliary manifestation of IgG4-related disease and may mimic other forms of sclerosing cholangiopathy, as well as cholangiocarcinoma. The clinical presentations of these diseases exhibit significant overlap, and diagnosis can be challenging. This case report discusses a 67-year-old male patient diagnosed with isolated IgG4-SC, who was initially suspected of having either cholangiocarcinoma or PSC.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86819"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-26eCollection Date: 2025-06-01DOI: 10.7759/cureus.86816
George K Annan, Patrick O Berchie, Alex Kumi, Moises Zouain Estevez, Chinenye Egwuonwu
{"title":"Methicillin-Resistant Staphylococcus aureus (MRSA) Strikes Deep: Infected Femoral Aneurysm in a Patient With Deep Vein Thrombosis.","authors":"George K Annan, Patrick O Berchie, Alex Kumi, Moises Zouain Estevez, Chinenye Egwuonwu","doi":"10.7759/cureus.86816","DOIUrl":"10.7759/cureus.86816","url":null,"abstract":"<p><p>Infectious (mycotic) aneurysms are rare but potentially life-threatening complications of bacteremia. They account for a small percentage of all aneurysms. Early recognition is essential to prevent catastrophic outcomes. We report a case of a 53-year-old man with a history of methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) nasal abscess who presented with fever, vomiting, and progressive right leg swelling. He was febrile and tachycardic. Labs showed neutrophilic leukocytosis (white cell count of 17.4 x 10⁹/L), elevated C-reactive protein (CRP; 127.4 mg/L), and positive blood cultures for MRSA. Doppler ultrasound revealed acute deep vein thrombosis (DVT) in the right femoral and deep veins. Despite vancomycin, he had persistent bacteremia, and antibiotics were escalated to ceftaroline and daptomycin. Computed tomography (CT) angiography obtained for worsening leg swelling revealed a 6.4 x 6.3 x 7.3 cm right superficial femoral artery aneurysm. He underwent urgent excision, ligation, and bypass, followed by serial surgical washouts. The infectious aneurysm likely resulted from local vascular inflammation caused by an infected thrombus or hematogenous seeding. Persistent fever and worsening leg swelling despite therapy warranted further imaging. MRSA is a well-documented cause of mycotic aneurysms and requires aggressive treatment. In patients with bacteremia and DVT who deteriorate despite treatment, infectious aneurysm should be considered. Early imaging and multidisciplinary care are crucial in preventing rupture and limb loss.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86816"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-25eCollection Date: 2025-06-01DOI: 10.7759/cureus.86738
Katarzyna Kubińska, Magdalena Zgoda-Aleksandrowicz, Anita Franczak-Young, Agata Hałabuda, Stanisław Kwiatkowski
{"title":"Non-accidental Trauma as an Example of an Underestimated Problem in Pediatrics: Maltreated Child Syndrome and Shaken Baby Syndrome.","authors":"Katarzyna Kubińska, Magdalena Zgoda-Aleksandrowicz, Anita Franczak-Young, Agata Hałabuda, Stanisław Kwiatkowski","doi":"10.7759/cureus.86738","DOIUrl":"10.7759/cureus.86738","url":null,"abstract":"<p><p>Injuries, including both accidental and non-accidental trauma, represent a common reason for hospitalization in the pediatric population. The impact of violence in the caregiver-child relationship is an important and often underestimated problem in pediatrics. Child abuse can present itself in various forms, including both psychological and physical manifestations. This study details the maltreated child syndrome and the shaken baby syndrome, also known as abusive head trauma. Non-accidental trauma presents with a broad spectrum of neurological symptoms, along with multiple injuries at different stages of healing and potential indicators of shaking. A two-month-old male infant presented with body spasms, subsequently accompanied by muscle flaccidity, following an accident of unclear mechanism. Imaging studies revealed bilateral subdural hematohygroma with acute hemorrhage, multiple fractures in various stages of healing, and retinal hemorrhage. Clinical, psychological, and social findings were consistent with shaken baby syndrome and maltreated child syndrome, suggesting non-accidental trauma. Beyond the current injuries, it is significant to be aware of the long-term effects of violence, particularly psychological and social aspects related to neurological damage. The role of medical staff is not only to provide medical help but also to ensure the child's safety and prevent a negative impact on their psychosocial development. Knowing how to recognize the signs of child abuse is relevant.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86738"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-25eCollection Date: 2025-06-01DOI: 10.7759/cureus.86740
Mary Arsenia N Mondiguing, Karl Coycoyen, Monique Goygoyan, Jay Adrian Taguiling, Kc Chakiwag, Winston Calde, Kiarei Dao-Ayan, Clar Renzel Bombase, Mark Rigor, Athena May Catores
{"title":"Prevalence and Risk Factors of Dry Eye Syndrome Among Medical Students in the Northern Philippines: A Cross-Sectional Survey.","authors":"Mary Arsenia N Mondiguing, Karl Coycoyen, Monique Goygoyan, Jay Adrian Taguiling, Kc Chakiwag, Winston Calde, Kiarei Dao-Ayan, Clar Renzel Bombase, Mark Rigor, Athena May Catores","doi":"10.7759/cureus.86740","DOIUrl":"10.7759/cureus.86740","url":null,"abstract":"<p><p>Introduction Dry eye syndrome (DES) accounts for the majority of ophthalmological consultations and should be considered a high-priority health concern. DES can be progressive and has significant consequences for an individual's vision and quality of life. This study aims to fill the information gap regarding the prevalence and risk factors of DES among medical students at Saint Louis University (SLU) in the northern part of the Philippines during the \"New Normal\" period. Methods A cross-sectional survey was conducted among 236 medical students. The dependent variable, the Ocular Surface Disease Index (OSDI), and independent variables were assessed using a questionnaire created with Google Forms (Google, Inc., Mountain View, CA). The Perceived Stress Scale-4 (PSS-4) was used to determine the level of stress of the students. Descriptive and analytical statistics were used to determine the risk factors associated with the OSDI scores of the participants. Results The prevalence of DES, as determined by the OSDI questionnaire, was 194 out of 236 (82.20%). The mean OSDI score of the cohort was 30.16 ± 6.99, with a 95% confidence level. This study revealed that the factors of sex, error of refraction (EOR), and psychological stress showed significant correlations with the OSDI score, as determined by Chi-square analysis with p-values of 0.013, 0.001, and 0.006, respectively. The female sex and those with errors of refraction (EOR) had a higher risk of developing DES. There is also a direct relationship between psychological stress and DES. The higher the perceived psychological stress, the higher the OSDI score. Psychological stress among the students was at 231/236 (97.87%). Conclusion Dry eye syndrome is increasingly recognized as a significant health issue among young individuals due to the increasingly demanding nature of their lifestyles. This study identified a high prevalence of dry eye syndrome among medical students with female sex, error of refraction, and a high level of perceived stress as the significant risk factors. A longitudinal study involving different medical schools in the country, including clinical tests for DES, is recommended to better elucidate the relationship among the various risk factors. The results of this study serve as a basis for crafting policies to increase awareness, modify risk factors, and implement appropriate preventive measures.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86740"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-25eCollection Date: 2025-06-01DOI: 10.7759/cureus.86743
Andrea Messori, Beatrice Tognarelli, Janette Monzillo, Sabrina Trippoli
{"title":"Simplified Algorithm for Determining Value-Based Pricing of High-Tech Medical Devices in the Tuscany Region of Italy.","authors":"Andrea Messori, Beatrice Tognarelli, Janette Monzillo, Sabrina Trippoli","doi":"10.7759/cureus.86743","DOIUrl":"10.7759/cureus.86743","url":null,"abstract":"<p><p>In Europe, value-based pricing (VBP) is widely used for pharmaceuticals but less frequently for medical devices. Medical device prices are generally set at the regional level and rarely at the national level. Therefore, a simple algorithm for estimating VBP can be useful. In Tuscany (a region with 3.7 million inhabitants), prices for high-tech medical devices have been set by a regional organization since 2018. These prices represent a mandatory condition for purchasing these devices but are generally determined empirically. In this context, we present a simplified algorithm for VBP estimation, which we have applied retrospectively to devices approved in the first half of 2024. The algorithm is based on the primary clinical endpoint used in the device studies and on health-care costs. It represents a modified version of the previously described added therapeutic value (ATV) model. To analyze the results of our experience, we performed a correlation analysis between VBPs and real prices. Our algorithm was applied to 17 devices. In 13 cases, the VBP could be estimated, while in the remaining four cases, the algorithm failed. In cases where the calculation was successful, the correlation between VBP and real prices was highly significant (R<sup>2</sup>=0.929; 95% confidence interval (CI), 0.7747 to 0.9789; p<0.001). In our previous experiences between 2019 and 2023, we attempted to apply a complete economic analysis to 239 newly approved devices and found that such an analysis was unfeasible in 80% of the cases. This simplified algorithm can be useful to determine a preliminary estimate of VBP when a more complete economic analysis is unfeasible.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86743"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-24eCollection Date: 2025-06-01DOI: 10.7759/cureus.86698
Leone Sutanto, Ka Man Cheung, Chung Hang James Chow, Ho Yin Harry Yiu
{"title":"Outcome of Pulmonary Large Cell Neuroendocrine Carcinoma After Definitive Treatment: A Single-Center Retrospective Review.","authors":"Leone Sutanto, Ka Man Cheung, Chung Hang James Chow, Ho Yin Harry Yiu","doi":"10.7759/cureus.86698","DOIUrl":"10.7759/cureus.86698","url":null,"abstract":"<p><p>Introduction Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive form of lung cancer. Given its poor prognosis and limited representation in clinical trials, the optimal treatment strategy remains undefined. This study aims to evaluate treatment modalities and clinical outcomes among LCNEC patients who received definitive treatment. Methods A retrospective review was conducted for patients diagnosed with LCNEC from 2000 to 2022 in a tertiary center. Clinical characteristics, staging, treatment modalities, molecular testing, and survival outcomes were collected. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates. Results Twenty-seven patients were included. The median age was 69.6 years; most were male (92.6%) and smokers (92.6%). Distribution by stage was as follows: I (29.6%), II (22.2%), and III (48.1%). Surgery was performed in 77.8%, and 33.3% received chemoradiotherapy. Adjuvant platinum-etoposide chemotherapy was administered in 42.8% of surgical cases. With a median follow-up of 75.9 months, the median PFS and OS were 9.6 and 20.8 months, respectively. The median OS by stage was as follows: I (30.2 months), II (23.5 months), and III (14.9 months). The recurrence rate was high (85.2%), with distant relapse being the most common (63%). Locoregional control was achieved in 40.7% of patients. Actionable mutations were detected in one patient (3.7%), and comprehensive molecular testing was underutilized. Conclusion LCNEC remains a clinically aggressive tumor with poor outcomes despite definitive treatment. The high recurrence rate, particularly in advanced stages, highlights the need for improved systemic strategies. Broader adoption of molecular profiling may uncover therapeutic targets and support the integration of emerging treatments, including immunotherapy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86698"},"PeriodicalIF":1.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-24eCollection Date: 2025-06-01DOI: 10.7759/cureus.86688
Haider Merchant, Joanna Tarr
{"title":"Improving Acute Care Preparedness Amongst Medical Students: A Systematic Review.","authors":"Haider Merchant, Joanna Tarr","doi":"10.7759/cureus.86688","DOIUrl":"10.7759/cureus.86688","url":null,"abstract":"<p><p>Evidence suggests that there is inadequate preparation for acute care within the undergraduate medical curriculum. Although previous attempts have been made to address this concern, a lack of formal evaluation of intervention effectiveness limits their utility. This review aimed to identify educational interventions seeking to prepare medical students for acute care and evaluate their effectiveness. MEDLINE, CENTRAL, Embase, Scopus and Web of Science were systematically searched. Primary research studies published between 2000 and 2020 and reporting changes in outcomes related to medical student preparation for acute care were included. Study outcomes were described as either highly effective, effective, ineffective, negative or variable. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI). Studies with an MERSQI score of ≥14 were classed as high-quality. Overall, 72 studies were included in this review. The majority were single-group pre- and post-test studies (n=39, 54.2%) and none measured changes in student behaviour or patient/healthcare outcomes. Courses, clerkships, and simulation were found to be the most effective interventions. All Clerkship studies measuring improvements in acute care skills were effective or highly effective. Mean MERSQI score was 12.4 (range=7.8-15.5, SD=1.7) and 18 studies (25%) were classed as high-quality. This review favours the use of clerkships, as well as courses and simulation. However, considerable heterogeneity and numerous study limitations prevent firm conclusions from being drawn. Future high-quality studies, especially those measuring behavioural changes and patient/healthcare outcomes, are subsequently needed. Reviews with a more focused area of research, those assessing long-term outcomes and cost-effectiveness, would additionally prove beneficial.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86688"},"PeriodicalIF":1.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12195642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-24eCollection Date: 2025-06-01DOI: 10.7759/cureus.86700
Hridya Harimohan, Mia Yasonova, Marah Sukkar, Katayoun Sabetian
{"title":"A Rare Case of Lambert-Eaton Myasthenia Syndrome With Dysphasia and Dysarthria.","authors":"Hridya Harimohan, Mia Yasonova, Marah Sukkar, Katayoun Sabetian","doi":"10.7759/cureus.86700","DOIUrl":"10.7759/cureus.86700","url":null,"abstract":"<p><p>Lambert-Eaton Myasthenic Syndrome (LEMS) is a rare autoimmune disorder resulting in muscle weakness. LEMS typically presents with progressive proximal muscle weakness, especially in the lower extremities, areflexia, and autonomic dysfunction. Bulbar involvement and respiratory compromise tend to occur later in the disease course and usually in severe, advanced cases. We report a unique case of a 50-year-old male with a known history of LEMS, autoimmune retinopathy, erectile dysfunction, and prediabetes who presented with progressive bulbar symptoms - slurred speech and difficulty swallowing - without accompanying weakness in the upper or lower extremities. Despite receiving four doses of intravenous immunoglobulin (IVIG) prior to admission with no improvement, he showed a significant clinical response to six sessions of plasmapheresis. Notably, the absence of limb weakness and preserved motor strength throughout his hospital stay raised diagnostic uncertainty, prompting evaluation for myasthenia gravis, which was ruled out through negative acetylcholine receptor antibody testing and reaffirmed voltage-gated calcium channel (VGCC) antibody positivity. Chest imaging showed no underlying malignancy. This case illustrates an atypical LEMS presentation dominated by severe bulbar dysfunction in the absence of limb involvement or respiratory failure, which is uncommon and may mimic other neuromuscular junction disorders such as myasthenia gravis. The favorable response to plasmapheresis emphasizes the importance of early recognition and aggressive immunomodulatory treatment in preventing clinical deterioration. Clinicians should maintain a high index of suspicion for LEMS even in unusual presentations to ensure timely and appropriate management.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86700"},"PeriodicalIF":1.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-06-24eCollection Date: 2025-06-01DOI: 10.7759/cureus.86654
Turgut Emre Erdem, Alper Kirilmaz, Ahmet Fevzi Kekec
{"title":"Diagnostic Performance of ChatGPT-4o in Detecting Hip Fractures on Pelvic X-rays.","authors":"Turgut Emre Erdem, Alper Kirilmaz, Ahmet Fevzi Kekec","doi":"10.7759/cureus.86654","DOIUrl":"10.7759/cureus.86654","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures are a major orthopedic problem, especially in the elderly population. Hip fractures are usually diagnosed by clinical evaluation and imaging, especially X-rays. In recent years, new approaches to fracture detection have emerged with the use of artificial intelligence (AI) and deep learning techniques in medical imaging. In this study, we aimed to evaluate the diagnostic performance of ChatGPT-4o, an artificial intelligence model, in diagnosing hip fractures.</p><p><strong>Methodology: </strong>A total of 200 anteroposterior pelvic X-ray images were retrospectively analyzed. Half of the images belonged to patients with surgically confirmed hip fractures, including both displaced and non-displaced types, while the other half represented patients with soft tissue trauma and no fractures. Each image was evaluated by ChatGPT-4o through a standardized prompt, and its predictions (fracture vs. no fracture) were compared against the gold standard diagnoses. Diagnostic performance metrics such as sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve, Cohen's kappa, and F1 score were calculated.</p><p><strong>Results: </strong>ChatGPT-4o demonstrated an overall accuracy of 82.5% in detecting hip fractures on pelvic radiographs, with a sensitivity of 78.0% and specificity of 87.0%. PPVs and NPVs were 85.7% and 79.8%, respectively. The area under the ROC curve (AUC) was 0.825, indicating good discriminative performance. Among 22 false-negative cases, 68.2% were non-displaced fractures, suggesting the model had greater difficulty identifying subtle radiographic findings. Cohen's kappa coefficient was 0.65, showing substantial agreement with actual diagnoses. Chi-square analysis revealed a strong correlation (χ² = 82.59, <i>P</i> < 0.001), while McNemar's test (<i>P</i> = 0.176) showed no significant asymmetry in error distribution.</p><p><strong>Conclusions: </strong>ChatGPT-4o shows promising accuracy in identifying hip fractures on pelvic X-rays, especially when fractures are displaced. However, its sensitivity drops significantly for non-displaced fractures, leading to many false negatives. This highlights the need for caution when interpreting negative AI results, particularly when clinical suspicion remains high. While not a replacement for expert assessment, ChatGPT-4o may assist in settings with limited specialist access.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86654"},"PeriodicalIF":1.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}