Is CT plus LP Necessary to Rule Out Subarachnoid Hemorrhage?

Results of a large prospective study support the practice of using the combination of negative CT plus negative lumbar puncture to rule out subarachnoid hemorrhage in ED patients with acute headache.

Subarachnoid hemorrhage (SAH) is a rare but potentially deadly cause of headache. The initial emergency department presentation of headache caused by an aneurismal sentinel bleed might be the only opportunity to make the diagnosis before a potentially catastrophic bleed. The combination of noncontrast head computed tomography (CT) followed by lumbar puncture (LP) if the CT scan is negative (CT/LP) has long been considered standard care in the ED work-up for SAH, but the validity of this approach is not well documented.

These authors prospectively assessed the sensitivity and specificity of CT/LP for ruling out SAH in 592 consecutive neurologically normal adult patients who presented to two tertiary care EDs during 3 years with nontraumatic a…

Reviewing Author

Richard D. Zane, MD, FAAEM

Disclosures

Nothing to disclose

Richard D. Zane, MD, FAAEM

Disclosures

Nothing to disclose