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Acad Emerg Med. 2015 Nov;22(11):1267-73. doi: 10.1111/acem.12811. Epub 2015 Oct 19.

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 information

1
Department of Neurosurgery, Queen's Hospital, Barking, Havering and Redbridge NHS Trust, Romford, Essex.
2
Department of Emergency Medicine, Bart's Health NHS Trust, London, UK.
3
Department of Emergency Medicine, St. Thomas Hospital, London, UK.
4
Department of Pathology, Queen's Hospital, Barking, Havering and Redbridge NHS Trust, Romford, Essex.
5
Department of Biochemistry, Royal London Hospital, London, UK.
6
Department of Emergency Medicine, Queen Mary University of London, London, UK.

Abstract

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 LPs that did not exclude SAH.

RESULTS:

A total of 2,248 patients were included. A total of 1,898 LPs 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.

PMID:
26480290
DOI:
10.1111/acem.12811
[Indexed for MEDLINE]
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