OBJECTIVE: To demonstrate the extent of compliance with established guidelines for the investigation of suspected subarachnoid haemorrhage (SAH) and the implications of non-compliance. DESIGN: Prospective observational study of practice in three hospitals in the Trent region. SETTING: One teaching hospital with a tertiary neuroscience referral centre and two large district general hospitals. PARTICIPANTS: 50 consecutive patients from each centre referred for suspected SAH with negative computed tomography. MAIN OUTCOME MEASURES: Diagnosis of SAH confirmed or excluded according to guidelines. RESULTS: When the data from the three centres were combined (n = 150 computed tomography negative cases) cerebrospinal fluid (CSF) investigation was not performed in 60/150 (40%). In the 90 cases where CSF studies were performed SAH was confirmed in 11 (12%). CONCLUSION: There is significant non-compliance in following the established guidelines for the investigation of SAH at the centres studied. As the primary cause of non-traumatic SAH is ruptured aneurysm, which is associated with high morbidity and mortality from second haemorrhage, this highlights a major source of concern for clinical governance.
OBJECTIVE: To demonstrate the extent of compliance with established guidelines for the investigation of suspected subarachnoid haemorrhage (SAH) and the implications of non-compliance. DESIGN: Prospective observational study of practice in three hospitals in the Trent region. SETTING: One teaching hospital with a tertiary neuroscience referral centre and two large district general hospitals. PARTICIPANTS: 50 consecutive patients from each centre referred for suspected SAH with negative computed tomography. MAIN OUTCOME MEASURES: Diagnosis of SAH confirmed or excluded according to guidelines. RESULTS: When the data from the three centres were combined (n = 150 computed tomography negative cases) cerebrospinal fluid (CSF) investigation was not performed in 60/150 (40%). In the 90 cases where CSF studies were performed SAH was confirmed in 11 (12%). CONCLUSION: There is significant non-compliance in following the established guidelines for the investigation of SAH at the centres studied. As the primary cause of non-traumatic SAH is ruptured aneurysm, which is associated with high morbidity and mortality from second haemorrhage, this highlights a major source of concern for clinical governance.
Authors: M R Mayberg; H H Batjer; R Dacey; M Diringer; E C Haley; R C Heros; L L Sternau; J Torner; H P Adams; W Feinberg Journal: Stroke Date: 1994-11 Impact factor: 7.914