Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage
Introduction: Application of a clinical decision rule for subarachnoid hemorrhage, in combination with cranial computed tomography (CT) performed within six hours of ictus (early cranial CT), may be able to reasonably exclude a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH). This study’s...
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doaj-68fc938a146a469bad7fa95e1b1ac3292020-11-24T23:12:14ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182015-10-0116567167610.5811/westjem.2015.7.25894Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid HemorrhageDustin G. Mark0Mamata V. Kene1Natalia Udaltsova2David R. Vinson3Dustin W. Ballard4Kaiser Permanente, Department of Emergency Medicine, Oakland, CaliforniaKaiser Permanente, Department of Emergency Medicine, San Leandro, CaliforniaKaiser Permanente Northern California, Division of Research, Oakland, CaliforniaKaiser Permanente, Department of Emergency Medicine, Roseville, California Kaiser Permanente, Department of Emergency Medicine, Roseville, California Introduction: Application of a clinical decision rule for subarachnoid hemorrhage, in combination with cranial computed tomography (CT) performed within six hours of ictus (early cranial CT), may be able to reasonably exclude a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH). This study’s objective was to examine the sensitivity of both early cranial CT and a previously validated clinical decision rule among emergency department (ED) patients with aSAH and a normal mental status. Methods: Patients were evaluated in the 21 EDs of an integrated health delivery system between January 2007 and June 2013. We identified by chart review a retrospective cohort of patients diagnosed with aSAH in the setting of a normal mental status and performance of early cranial CT. Variables comprising the SAH clinical decision rule (age >40, presence of neck pain or stiffness, headache onset with exertion, loss of consciousness at headache onset) were abstracted from the chart and assessed for inter-rater reliability. Results: One hundred fifty-five patients with aSAH met study inclusion criteria. The sensitivity of early cranial CT was 95.5% (95% CI [90.9-98.2]). The sensitivity of the SAH clinical decision rule was also 95.5% (95% CI [90.9-98.2]). Since all false negative cases for each diagnostic modality were mutually independent, the combined use of both early cranial CT and the clinical decision rule improved sensitivity to 100% (95% CI [97.6-100.0]). Conclusion: Neither early cranial CT nor the SAH clinical decision rule demonstrated ideal sensitivity for aSAH in this retrospective cohort. However, the combination of both strategies might optimize sensitivity for this life-threatening disease.http://escholarship.org/uc/item/1xd110pqAneurysmal subarachnoid hemorrhagecomputed tomography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dustin G. Mark Mamata V. Kene Natalia Udaltsova David R. Vinson Dustin W. Ballard |
spellingShingle |
Dustin G. Mark Mamata V. Kene Natalia Udaltsova David R. Vinson Dustin W. Ballard Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage Western Journal of Emergency Medicine Aneurysmal subarachnoid hemorrhage computed tomography |
author_facet |
Dustin G. Mark Mamata V. Kene Natalia Udaltsova David R. Vinson Dustin W. Ballard |
author_sort |
Dustin G. Mark |
title |
Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage |
title_short |
Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage |
title_full |
Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage |
title_fullStr |
Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage |
title_full_unstemmed |
Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage |
title_sort |
sensitivity of a clinical decision rule and early computed tomography in aneurysmal subarachnoid hemorrhage |
publisher |
eScholarship Publishing, University of California |
series |
Western Journal of Emergency Medicine |
issn |
1936-900X 1936-9018 |
publishDate |
2015-10-01 |
description |
Introduction: Application of a clinical decision rule for subarachnoid hemorrhage, in combination with
cranial computed tomography (CT) performed within six hours of ictus (early cranial CT), may be able
to reasonably exclude a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH). This study’s
objective was to examine the sensitivity of both early cranial CT and a previously validated clinical
decision rule among emergency department (ED) patients with aSAH and a normal mental status.
Methods: Patients were evaluated in the 21 EDs of an integrated health delivery system between
January 2007 and June 2013. We identified by chart review a retrospective cohort of patients
diagnosed with aSAH in the setting of a normal mental status and performance of early cranial CT.
Variables comprising the SAH clinical decision rule (age >40, presence of neck pain or stiffness,
headache onset with exertion, loss of consciousness at headache onset) were abstracted from the
chart and assessed for inter-rater reliability.
Results: One hundred fifty-five patients with aSAH met study inclusion criteria. The sensitivity of
early cranial CT was 95.5% (95% CI [90.9-98.2]). The sensitivity of the SAH clinical decision rule
was also 95.5% (95% CI [90.9-98.2]). Since all false negative cases for each diagnostic modality
were mutually independent, the combined use of both early cranial CT and the clinical decision rule
improved sensitivity to 100% (95% CI [97.6-100.0]).
Conclusion: Neither early cranial CT nor the SAH clinical decision rule demonstrated ideal
sensitivity for aSAH in this retrospective cohort. However, the combination of both strategies might
optimize sensitivity for this life-threatening disease. |
topic |
Aneurysmal subarachnoid hemorrhage computed tomography |
url |
http://escholarship.org/uc/item/1xd110pq |
work_keys_str_mv |
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