Clinical characteristics suggesting subarachnoid hemorrhage in acute headache.

January 01, 0001

Clinical characteristics suggesting subarachnoid hemorrhage in acute headache.

Headache is a common complaint, and determining which patients need imaging studies can be a challenge. These Canadian researchers sought to identify high risk clinical clues for subarachnoid hemorrhage in neurologically intact patients with non-traumatic headache peaking within one hour via a multicentre prospective cohort study.

The researchers found: "In the 1999 patients enrolled there were 130 cases of subarachnoid haemorrhage. Mean (range) age was 43.4 (16-93), 1207 (60.4%) were women, and 1546 (78.5%) reported that it was the worst headache of their life. Thirteen of the variables collected on history and three on examination were reliable and associated with subarachnoid haemorrhage. We used recursive partitioning with different combinations of these variables to create three clinical decisions rules. All had 100% sensitivity with specificities from 28.4% to 38.8%. Use of any one of these rules would have lowered rates of investigation (computed tomography, lumbar puncture, or both) from the current 82.9% to between 63.7% and 73.5%."

The researchers concluded: "Clinical characteristics can be predictive for subarachnoid haemorrhage. Practical and sensitive clinical decision rules can be used in patients with a headache peaking within an hour. Further study of these proposed decision rules, including prospective validation, could allow clinicians to be more selective and accurate when investigating patients with headache."

Demonstrates important clinical findings that can be incorporated into a decision tool to determine which headache patients need imaging.

For the full abstract, click here.

BMJ 341:c5204, 28 October 2010 © 2010 Perry et al.
High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. Jeffrey J Perry, Ian G Stiell, Marco L A Sivilotti, et al. Correspondence to J Perry: [email protected]

Category: N. Neurological. Keywords: subarachnoid hemorrhage, severity, history, lumbar puncture, computerized tomography, prospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 16 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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