Ottawa Subarachnoid Hemorrhage Rule Is 100% Sensitive and Can Rule Out the Diagnosis

However, with a specificity of only 13.6%, its impact on imaging and lumbar puncture rates may be low.

Given the potential severity of missed subarachnoid hemorrhage (SAH), the diagnosis is an ideal one for a highly sensitive clinical decision rule. We previously summarized the Ottawa SAH Rule in 2013 (NEJM JW Emerg Med Nov 2013 and JAMA 2013; 310:1248) but noted its lack of validation and low specificity (15%) as barriers to use. Briefly, the rule is meant for neurologically intact patients 16 years or older with an atraumatic headache that peaked within 1 hour of onset. No further evaluation is needed if none of these six variables are present: age >40, neck pain or stiffness, witnessed loss of consciousness, exertional onset, thunderclap onset (immediate peaked pain), and limited neck flexion on exam.

The researchers validated their rule i…

Reviewing Author

Ali S. Raja, MD, MBA, MPH

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

Disclosures

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

Ottawa Subarachnoid Hemorrhage Rule Is 100% Sensitive and Can Rule Out the Diagnosis

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Reviewing Author