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Two recent studies reported a negative predictive value of 100% for third-generation brain computed tomography (CT) scans performed within 6 hours after onset of acute headache in patients with suspected aneurysmal subarachnoid hemorrhage (SAH; NEJM JW Emerg Med Sep 2011 and BMJ 2011; 343:d4277; and Stroke 2012; 43:2115). Both studies were performed in university-affiliated tertiary care hospitals where CT scans were interpreted by neuroradiologists or experienced general radiologists.
To determine whether these findings apply in the nonacademic setting, researchers retrospectively studied consecutive patients with acute headache who presented to 11 community hospitals in the Netherlands. Eligible patients had a brain CT scan within 6 hours …