Use CT — Without LP — to Rule Out Subarachnoid Hemorrhage Within 6 Hours of Onset

For patients presenting after 6 hours, lumbar puncture is still needed, at least for now.

Spontaneous subarachnoid hemorrhage (SAH) is uncommon but can be fatal; the diagnosis is often at the front of emergency physicians' minds when evaluating a patient with sudden-onset headache. The mainstay of diagnosis has been the combination of an unenhanced computed tomography (CT) scan followed, if negative, by a lumbar puncture (LP; NEJM JW Emerg Med Jan 2013 and Acad Emerg Med 2012; 19:1134). However, the improved sensitivity of modern CT technology may obviate the need for LP, especially in the initial hours of the disease.

Researchers performed a high-quality meta-analysis focused on the diagnostic accuracy of history, physical examination, LP, CT, and clinical decision rules for SAH. Among 22 studies included in the analysis, the av…

Reviewing Author

Ali S. Raja, MD, MBA, MPH, FACEP

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Ali S. Raja, MD, MBA, MPH, FACEP

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Use CT — Without LP — to Rule Out Subarachnoid Hemorrhage Within 6 Hours of Onset

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Reviewing Author