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Sensitivity of proposed clinical decision rules for subarachnoid haemorrhage: An external validation study
Author(s) -
Kelly AnneMaree,
Klim Sharon,
Edward Simon,
Millar Nicola
Publication year - 2014
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12325
Subject(s) - medicine , interquartile range , confidence interval , vomiting , cohort , retrospective cohort study , subarachnoid hemorrhage , cohort study , gold standard (test) , pediatrics
Objectives Subarachnoid haemorrhage ( SAH ) is an uncommon but important cause of sudden‐onset headache. Three clinical decision rules ( CDRs ) for investigation in sudden headache have been proposed, but concerns were raised about the generalisability of some variables. Our aim was to determine what proportion of patients with confirmed SAH has the identified high‐risk factors and the sensitivity of the proposed CDR in an Australasian cohort. Methods This is a retrospective cohort study of alert and neurologically intact adult patients with confirmed SAH attending two community teaching hospitals between 2000 and 2011. The outcomes of interest were the proportion of patients with each high‐risk criterion (descriptive statistics) and sensitivity of each proposed CDR (%, interquartile range [IQR]). Results There were 59 confirmed SAH that met the inclusion criteria. Sensitivity of proposed CDR 1 was 96.6% (95% confidence interval [ CI ] 88.5–99.1%), sensitivity of proposed CDR 2 was 100% (95% CI 93.9–100%) and sensitivity of proposed CDR 3 was 89.8% (95% CI 79.5–95.3%). The addition of vomiting to the criteria in CDR s 1 and 3 increased the sensitivity of both these CDR s to 100%. Conclusion CDR 2, or the refinement of CDR s 1 and 3 with the inclusion of at least one episode of vomiting as a criterion, has very high sensitivity. Although unlikely to reduce CT scan rates for patients in whom there is a clinical suspicion of SAH , they might be useful in guiding which patients require further testing (e.g. lumbar puncture) after a negative CT scan.