David Sayer1, Ben Bloom2, Katalin Fernando3, Stuart Jones4, Sally Benton5, Shumontha Dev3, Sathish Deverapalli2, Tim Harris2,6. 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.
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.
Authors: Christopher R Carpenter; Adnan M Hussain; Michael J Ward; Gregory J Zipfel; Susan Fowler; Jesse M Pines; Marco L A Sivilotti Journal: Acad Emerg Med Date: 2016-09-06 Impact factor: 3.451
Authors: Daniel Alejandro Vega-Moreno; María Elena Córdoba-Mosqueda; José Ramón Aguilar-Calderón; Rodrigo Efraín Hernández-Resendiz; Heberseleth Valdivia-Chiñas; Erick Alberto Castañeda-Ramírez; Óscar Medina-Carrillo; Rafael Sánchez-Mata Journal: Ann Med Surg (Lond) Date: 2020-08-21