Practice Variation in the Diagnosis of Aneurysmal Subarachnoid Hemorrhage: A Survey of US and Canadian Emergency Medicine Physicians.

Neurocritical Care
Aarti KumarPrasanthi Govindarajan

Abstract

Spontaneous subarachnoid hemorrhage (SAH) from a brain aneurysm, if untreated in the acute phase, leads to loss of functional independence in about 30% of patients and death in 27-44%. To evaluate for SAH, the American College of Emergency Physicians (ACEP) Clinical Policy recommends obtaining a non-contrast brain computed tomography (CT) scan followed by a lumbar puncture (LP) if the CT is negative. On the other hand, current evidence from prospectively collected data suggests that CT alone may be sufficient to rule out SAH in patients who present within 6 h of symptom onset while anecdotal evidence suggests that CT angiogram (CTA) may be used to detect aneurysms, which are the probable cause of SAH. Since many different options are available to emergency physicians, we examined their practice pattern variation by observing their diagnostic approaches and their adherence to the ACEP Clinical Policy. We developed, validated, and distributed a survey to emergency physicians at three practice sites: (1) Stanford Healthcare, California, (2) Intermountain Healthcare (five emergency departments), Utah, and (3) Ottawa General Hospital, Toronto. The survey questions examined physician knowledge on CT and LP's test performance and used...Continue Reading

References

Apr 17, 2004·Journal of Neurosurgery·Fang QuMichael N Diringer
Apr 8, 2010·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Robert F McCormack, Alan Hutson
Oct 3, 2012·Annals of Emergency Medicine·Dustin G MarkUNKNOWN Kaiser Permanente CREST Network Investigators
Sep 26, 2013·JAMA : the Journal of the American Medical Association·Jeffrey J PerryGeorge A Wells
Jun 17, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Christopher R CarpenterMarco L A Sivilotti

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Citations

May 14, 2021·International Journal of Emergency Medicine·Sima PatelOkorie Nduka Okorie

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