Sorry, Can't Stop Doing Lumbar Puncture to Rule Out Subarachnoid Hemorrhage

A clinical decision rule performed well, but CT within 6 hours missed 20% of cases.

Depending on the number of slices, computed tomography (CT) of the brain misses up to 7% of subarachnoid hemorrhages (SAH). But a recent study suggested that if CT was performed within 6 hours of headache onset, the miss rate was zero (JW Emerg Med Aug 5 2011). Another study provided a decision rule that excluded all cases of SAH (JW Gen Med Nov 9 2010). Now, researchers retrospectively applied the decision rule and assessed the sensitivity of CT within 6 hours in adults with SAH who presented to 21 Kaiser Permanente emergency departments (EDs) in California from 2000 to 2011. All patients had normal neurological exams, initial negative CT results, and >5 red blood cells/µL of cerebrospinal fluid (CSF). SAH was diagnosed on the basis of pre…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Sorry, Can't Stop Doing Lumbar Puncture to Rule Out Subarachnoid Hemorrhage

Topics

Reviewing Author