Clinical Decision Rules to Identify Patients at High Risk for Subarachnoid Hemorrhage

One of three rules might eliminate unnecessary evaluation of patients with acute headache.

Because subarachnoid hemorrhage (SAH) is a potentially devastating cause of acute headache, many patients with acute headache undergo extensive testing (e.g., computed tomography [CT], lumbar puncture) to rule it out. In this 5-year multicenter prospective Canadian study that involved nearly 2000 neurologically intact adults who presented with acute (peaking within 1 hour) nontraumatic headache, investigators sought to identify clinical characteristics that predicted SAH.

Overall, 130 patients had SAH. Sixteen clinical characteristics were associated significantly with SAH and were used to create three possible clinical decision rules:

Rule 1: age >40, complaint of neck pain or stiffness, witnessed loss of consciousness, onset of headache wit…

Reviewing Author

Paul S. Mueller, MD, MPH, FACP

Disclosures

Nothing to disclose

Paul S. Mueller, MD, MPH, FACP

Disclosures

Nothing to disclose