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An Observational Study of 2,248 Patients Presenting With Headache, Suggestive of Subarachnoid Hemorrhage, Who Received Lumbar Punctures Following Normal Computed Tomography of the Head
Author(s) -
Sayer David,
Bloom Ben,
Fernando Katalin,
Jones Stuart,
Benton Sally,
Dev Shumontha,
Deverapalli Sathish,
Harris Tim
Publication year - 2015
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12811
Subject(s) - medicine , subarachnoid hemorrhage , lumbar puncture , carotid cavernous fistula , lumbar , cerebrospinal fluid , radiology , emergency department , incidence (geometry) , fistula , surgery , physics , psychiatry , optics
Objectives The objective was to determine the incidence of subarachnoid hemorrhage ( SAH ) diagnosed by lumbar puncture ( LP ) when the head computed tomography ( CT ) was reported as demonstrating no subarachnoid blood. Methods Data were obtained on patients who received LP to diagnose or exclude SAH attending six hospitals over 5 years. Subsequent investigations and outcomes were reviewed in all patients with LP s that did not exclude SAH . Results A total of 2,248 patients were included. A total of 1,898 LP s were suitable for biochemical analysis, of which 92 (4.8%) were positive for blood, suggesting SAH ; 1,507 (79.4%) were negative; and 299 (15.6%) were inconclusive. Of the 92 patients with positive cerebrospinal fluid analysis, eight patients (0.4%) had aneurysms on further imaging, and one had a carotid cavernous fistula. Conclusions In patients presenting to the emergency department with acute severe headache, LP to diagnose or exclude SAH after negative head CT has a very low diagnostic yield, due to low prevalence of the disease and uninterpretable or inconclusive samples. A clinical decision rule may improve diagnostic yield by selecting patients requiring further evaluation with LP following nondiagnostic or normal noncontrast CT brain imaging.