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To determine how often initial noncontrast head computed tomography (CT) scans may be misinterpreted as normal in emergency department patients with aneurysmal subarachnoid hemorrhage (aSAH), investigators retrospectively reviewed records at a large health delivery system between 2007 and 2013. They identified 452 patients with a final diagnosis of aSAH, of whom 18 (4%) were diagnosed by lumbar puncture and angiography after their initial CT scans were interpreted as negative by a general radiologist or neuroradiologist.
Two independent, blinded, board-certified neuroradiologists reviewed the initial CT images for these 18 patients and rated them as showing definite (e.g., hyperattenuation in basilar cisterns), probable (e.g., isoattenuation…