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J Emerg Med. 2012 Jul;43(1):13-8. doi: 10.1016/j.jemermed.2011.09.012. Epub 2012 Feb 10.

Sensitivity of newer-generation computed tomography scanners for subarachnoid hemorrhage: a Bayesian analysis.

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  • 1Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Abstract

BACKGROUND:

Subarachnoid hemorrhage (SAH) is a life-threatening condition considered in patients presenting to the emergency department (ED) with acute and severe-onset headache. Currently, the practice pattern for suspected SAH is to perform a non-contrasted computed tomography (CT) scan of the head, followed by lumbar puncture (LP) if the CT is negative. Newer-generation 16-slice CT scanners have been shown in one study to be very sensitive for SAH.

OBJECTIVE:

We sought to validate these findings at our institution by retrospectively analyzing the sensitivity of our 16-slice or better CT scanner and performing a bayesian analysis with the results.

METHODS:

We utilized ED electronic medical records and the Department of Neurosurgery research database to search for patients admitted from the ED with a diagnosis of SAH from January 1, 2005 to December 31, 2008. We found a total of 134 patients admitted with SAH during this time frame.

RESULTS:

Average age was 53.8 years; 62% were female. Presenting complaint was headache in 57%, paresthesia or weakness in 7%, unresponsive in 10%, confusion or altered mental status in 5%, and "other" in 10%. Sensitivity of 16-slice or better CT scanner in our study was 131/134, or 97.8% (95% confidence interval 93.1-99.4%). No patient with a negative CT had a lesion requiring intervention.

CONCLUSION:

Our study confirms the high sensitivity of 16-slice or better CT scanners for SAH. This calls into question the need for LP after negative head CT when 16-slice CT or better is used.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
22326408
[PubMed - indexed for MEDLINE]
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