Diagnosis of subarachnoid haemorrhage following a negative computed tomography for acute headache: a Bayesian analysis

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
Timothy J Coats, Richard Loffhagen

Abstract

As access to computed tomography scanning has become easier, patients with a lower probability of serious pathology are being scanned. We asked how many lumbar punctures need to be performed to detect each subarachnoid haemorrhage in these lower-risk patients. Literature review and Bayesian analysis of the application of the data to clinical practice. A computed tomography scan for acute headache has a negative likelihood ratio of 0.02 if the computed tomography is performed at <12 h, 0.07 at <24 h and 0.18 at >24 h. A low pre-test probability, for example 1 in 20 (5%), and a negative computed tomography at <12 h means that more than 1000 lumbar punctures would be required to detect each subarachnoid haemorrhage. In patients who have a low pre-computed tomography probability of subarachnoid haemorrhage and undergo an early computed tomography scan, the risk/benefit ratio of lumbar puncture is unclear. A decision rule (risk stratification system) might improve our ability to help the patient make an informed choice.

References

Mar 1, 1995·Journal of Neurology, Neurosurgery, and Psychiatry·N van der WeeJ van Gijn
Feb 1, 1996·Neurologic Clinics·R W Evans
Jan 1, 1996·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·T A SamesM R Magoon
Jul 1, 1996·Journal of Neurology·M Vermeulen
Sep 1, 1996·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·R SidmanT Lemke
Mar 28, 1998·Neurologic Clinics·R W Evans
Mar 20, 1998·Annals of Emergency Medicine·R Zumwalt
Jan 6, 2000·The New England Journal of Medicine·J A Edlow, L R Caplan
Feb 7, 2001·Brain : a Journal of Neurology·J van Gijn, G J Rinkel
Mar 13, 2003·Emergency Medicine Clinics of North America·Jonathan A Edlow
Sep 27, 2003·BMJ : British Medical Journal·Adrian Edwards
Sep 27, 2003·BMJ : British Medical Journal·Tze-Wey Loong
Sep 27, 2003·BMJ : British Medical Journal·Gerd Gigerenzer, Adrian Edwards
Jul 20, 2004·BMJ : British Medical Journal·Jonathan J Deeks, Douglas G Altman

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Citations

Jan 1, 2009·International Journal of Emergency Medicine·Bilal MajedPatrick Vermersch
Aug 19, 2006·BMJ : British Medical Journal·Timothy J Coats
Apr 6, 2011·Critical Care : the Official Journal of the Critical Care Forum·Hongliang ZhangJiang Wu
Mar 7, 2012·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Ben FineR Loch Macdonald
Sep 5, 2014·Emergency Medicine Australasia : EMA·Andrew RogersKevin Chu
Oct 23, 2015·Emergency Medicine Journal : EMJ·Chris Gray, Bernard A Foëx
Jun 17, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Christopher R CarpenterMarco L A Sivilotti
Oct 23, 2018·Statistics in Biosciences·Wenqing LiDipak K Dey
Aug 20, 2010·Journal of Medical Imaging and Radiation Oncology·O MuhammedJ P Slavotinek
Apr 9, 2015·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Jamie G CooperTajek B Hassan
Mar 13, 2021·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Christophe BianchiPierre-Nicolas Carron

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