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Neurology. 2015 May 12;84(19):1927-32. doi: 10.1212/WNL.0000000000001562. Epub 2015 Apr 10.

CT within 6 hours of headache onset to rule out subarachnoid hemorrhage in nonacademic hospitals.

Author information

1
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.B., G.J.E.R., M.D.I.V.), and Department of Radiology (J. Hendrikse), University Medical Center Utrecht; Department of Radiology (C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Neurology (M.B., C.C.T.), St. Elisabeth Hospital, Tilburg; Department of Neurology (Y.Y.W., J. Hofmeijer), Rijnstate Hospital, Arnhem; Department of Neurology (J.E., B.K.), Sint Lucas Andreas Hospital, Amsterdam; Department of Neurology (T.H.C.M.L.S.), Atrium Medical Center, Heerlen; Department of Neurology (S.t.H., F.V.), Groene Hart Hospital, Gouda; Department of Neurology (L.H., D.M.O.P.), Diakonessenhuis, Utrecht; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam; Department of Neurology (P.J.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (M.J.M.R.), Amphia Hospital, Breda; Department of Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein; and Department of Neurology (N.D.K.), Slotervaart Hospital, Amsterdam, the Netherlands. N.D.K. is currently affiliated with the Department of Neurology, Leiden University Medical Center, the Netherlands.
2
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.B., G.J.E.R., M.D.I.V.), and Department of Radiology (J. Hendrikse), University Medical Center Utrecht; Department of Radiology (C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Neurology (M.B., C.C.T.), St. Elisabeth Hospital, Tilburg; Department of Neurology (Y.Y.W., J. Hofmeijer), Rijnstate Hospital, Arnhem; Department of Neurology (J.E., B.K.), Sint Lucas Andreas Hospital, Amsterdam; Department of Neurology (T.H.C.M.L.S.), Atrium Medical Center, Heerlen; Department of Neurology (S.t.H., F.V.), Groene Hart Hospital, Gouda; Department of Neurology (L.H., D.M.O.P.), Diakonessenhuis, Utrecht; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam; Department of Neurology (P.J.B.), Medisch Spectrum Twente, Enschede; Department of Neurology (M.J.M.R.), Amphia Hospital, Breda; Department of Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein; and Department of Neurology (N.D.K.), Slotervaart Hospital, Amsterdam, the Netherlands. N.D.K. is currently affiliated with the Department of Neurology, Leiden University Medical Center, the Netherlands. m.d.i.vergouwen@umcutrecht.nl.

Abstract

OBJECTIVE:

To investigate whether staff radiologists working in nonacademic hospitals can adequately rule out subarachnoid hemorrhage (SAH) on head CT <6 hours after headache onset.

METHODS:

In a multicenter, retrospective study, we studied a consecutive series of patients presenting with acute headache to 11 nonacademic hospitals. Inclusion criteria were (1) normal level of consciousness without focal deficits, (2) head CT <6 hours after headache onset and reported negative for the presence of SAH by a staff radiologist, and (3) subsequent CSF spectrophotometry. Two neuroradiologists and one stroke neurologist from 2 academic tertiary care centers independently reviewed admission CTs of patients with CSF results that were considered positive for presence of bilirubin according to local criteria. We investigated the negative predictive value for detection of SAH by staff radiologists in nonacademic hospitals on head CT in patients scanned <6 hours after onset of acute headache.

RESULTS:

Of 760 included patients, CSF analysis was considered positive for bilirubin in 52 patients (7%). Independent review of these patients' CTs identified one patient (1/52; 2%) with a perimesencephalic nonaneurysmal SAH. Negative predictive value for detection of subarachnoid blood by staff radiologists working in a nonacademic hospital was 99.9% (95% confidence interval 99.3%-100.0%).

CONCLUSIONS:

Our results support a change of practice wherein a lumbar puncture can be withheld in patients with a head CT scan performed <6 hours after headache onset and reported negative for the presence of SAH by a staff radiologist in the described nonacademic setting.

PMID:
25862794
DOI:
10.1212/WNL.0000000000001562
[Indexed for MEDLINE]

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