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Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Epub 2016 Jan 21.

Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

Author information

1
From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA (N.M.D., J.A.E.); Department of Emergency Medicine, Harvard Medical School, Boston, MA (N.M.D., J.A.E.); Departments of Emergency Medicine (M.F.B.) and Neurology (A.A.R.), Mayo Clinic, Rochester, MN. ndubosh@bidmc.harvard.edu.
2
From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA (N.M.D., J.A.E.); Department of Emergency Medicine, Harvard Medical School, Boston, MA (N.M.D., J.A.E.); Departments of Emergency Medicine (M.F.B.) and Neurology (A.A.R.), Mayo Clinic, Rochester, MN.

Abstract

BACKGROUND AND PURPOSE:

Emerging evidence demonstrating the high sensitivity of early brain computed tomography (CT) brings into question the necessity of always performing lumbar puncture after a negative CT in the diagnosis of spontaneous subarachnoid hemorrhage (SAH). Our objective was to determine the sensitivity of brain CT using modern scanners (16-slice technology or greater) when performed within 6 hours of headache onset to exclude SAH in neurologically intact patients.

METHODS:

After conducting a comprehensive literature search using Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus, we conducted a meta-analysis. We included original research studies of adults presenting with a history concerning for spontaneous SAH and who had noncontrast brain CT scan using a modern generation multidetector CT scanner within 6 hours of symptom onset. Our study adheres to the preferred reporting items for systematic reviews and meta-analyses (PRISMA).

RESULTS:

A total of 882 titles were reviewed and 5 articles met inclusion criteria, including an estimated 8907 patients. Thirteen had a missed SAH (incidence 1.46 per 1000) on brain CTs within 6 hours. Overall sensitivity of the CT was 0.987 (95% confidence intervals, 0.971-0.994) and specificity was 0.999 (95% confidence intervals, 0.993-1.0). The pooled likelihood ratio of a negative CT was 0.010 (95% confidence intervals, 0.003-0.034).

CONCLUSIONS:

In patients presenting with thunderclap headache and normal neurological examination, normal brain CT within 6 hours of headache is extremely sensitive in ruling out aneurysmal SAH.

KEYWORDS:

brain; cerebrospinal fluid; confidence intervals; headache; subarachnoid hemorrhage

PMID:
26797666
DOI:
10.1161/STROKEAHA.115.011386
[Indexed for MEDLINE]

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