Subarachnoid Hemorrhage Diagnosis: Is Advanced Imaging Better than CT Followed by LP?

In patients with a high pretest likelihood of SAH, a decision analysis shows that computed tomography followed by lumbar puncture is equivalent to CT alone or CT followed by CT angiography or magnetic resonance angiography.

To evaluate the most cost-effective strategy to diagnose subarachnoid hemorrhage (SAH) in a hypothetical 45-year-old patient with sudden-onset severe headache, researchers used a computer-based decision analysis model to compare four diagnostic approaches: computed tomography (CT) only, CT followed by lumbar puncture (LP), CT followed by magnetic resonance angiography, and CT followed by CT angiography. Data gleaned from the literature on the performance of the diagnostic modalities, side effects, outcomes, complications, and costs were entered into the model.

The model showed that whereas the incremental cost of the CT/LP strategy was modestly higher than that of the other three strategies, the total cost of all four strategies was similar.…

Reviewing Author

Diane M. Birnbaumer, MD, FACEP

Disclosures

Consultant / Advisory boardSecurisyn

Editorial boardsThe Merck Manuals (Home and Physician Editions)

Diane M. Birnbaumer, MD, FACEP

Disclosures

Consultant / Advisory boardSecurisyn

Editorial boardsThe Merck Manuals (Home and Physician Editions)