CT-LP Is Still the Appropriate Evaluation for Subarachnoid Hemorrhage

Cheryl Lynn Horton, MD reviewing Mark DG et al. West J Emerg Med 2015 Oct 20.

Although researchers found that combining early head computed tomography and the SAH clinical decision rule was 100% sensitive for diagnosing aneurysmal SAH, the study had significant weaknesses.

Head computed tomography (CT) imaging along with lumbar puncture (LP) has been the conventional evaluation for subarachnoid hemorrhage (SAH). Researchers reviewed records for 155 adults diagnosed with aneurysmal SAH after undergoing head CT within 6 hours of symptom onset at 21 California emergency departments from 2007 to 2013 to retrospectively assess whether applying the SAH clinical decision rule improves sensitivity for this diagnosis. The SAH clinical decision rule considers age ≥40 years, maximal pain at onset, symptom onset during exertion, and witnessed loss of consciousness as high-risk features requiring further investigation.

Head CT imaging and the SAH clinical decision rule each were 96% sensitive for the diagnosis of aneurysmal SAH. When the tests were combined, sensitivity was 100%.

Citation(s):

Mark DG et al. Sensitivity of a clinical decision rule and early computed tomography in aneurysmal subarachnoid hemorrhage. West J Emerg Med 2015 Oct 20; [e-pub].