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Hot Off the Press: An Observational Study of 2248 Patients Presenting with Headache, Suggestive of Subarachnoid Hemorrhage, that Received a Lumbar Puncture Following a Normal CT Head.
Acad Emerg Med. 2016 Feb 1;
Authors: Westafer LM, Carpenter CR, Milne WK
Abstract
Headache is a very common emergency department (ED) chief complaint, representing about 2.8% of all visits in the United States (U.S.).(1) Sudden onset, severe headache often warrants evaluation for etiologies with unacceptably high morbidity and lethality, including subarachnoid hemorrhage (SAH). Noncontrast head computed tomography (CT) as soon as possible after the onset of headache is the initial SAH diagnostic test of choice, but older studies indicate that up to one-in-three SAH patients were misdiagnosed during the initial ED encounter with subsequent treatment delays producing less optimal patient outcomes due to failure to perform or appropriately interpret lumbar puncture (LP) results in headache patients with a non-diagnostic CT.(2) Early generation CT studies reported inadequate sensitivities for the diagnosis of SAH so post-imaging LP was the standard work-up to adequately exclude SAH.(3) The American College of Emergency Physicians (ACEP) Clinical Policy Statement for the evaluation of adult headache patients currently provide a Level B recommendation supporting LP following non-diagnostic non-contrast head CT to rule out SAH.(4) Recent studies using newer generation CT scanners demonstrate significantly improved sensitivities for detecting SAH if performed within six hours, rendering providers and clinical educators to question the benefit for LP in this population.(5) This article is protected by copyright. All rights reserved.
PMID: 26834085 [PubMed - as supplied by publisher]