Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study

被引:214
作者
Perry, Jeffrey J. [1 ,2 ,3 ]
Stiell, Ian G. [3 ,4 ]
Sivilotti, Marco L. A. [5 ,6 ,7 ,8 ]
Bullard, Michael J. [10 ]
Emond, Marcel [11 ]
Symington, Cheryl [3 ]
Sutherland, Jane [12 ]
Worster, Andrew [13 ]
Hohl, Corinne [14 ]
Lee, Jacques S. [15 ]
Eisenhauer, Mary A. [16 ]
Mortensen, Melodie [3 ]
Mackey, Duncan [9 ]
Pauls, Merril [17 ]
Lesiuk, Howard [18 ]
Wells, George A. [19 ]
机构
[1] Univ Ottawa, Dept Emergency Med, Clin Epidemiol Program, Emergency Med,Ottawa Hosp Res Inst, Ottawa, ON, Canada
[2] Univ Ottawa, Dept Emergency Med, Clin Epidemiol Program, Epidemiol & Community Med,Ottawa Hosp Res Inst, Ottawa, ON, Canada
[3] Univ Ottawa, Dept Emergency Med, Clin Epidemiol Program, Ottawa Hosp Res Inst, Ottawa, ON, Canada
[4] Univ Ottawa, Dept Emergency Med, Clin Epidemiol Program, Ottawa Hosp Res Inst,Dept Emergency Med, Ottawa, ON, Canada
[5] Queens Univ, Dept Emergency Med, Emergency Med, Kingston, ON, Canada
[6] Queens Univ, Dept Emergency Med, Pharmacol & Toxicol, Kingston, ON, Canada
[7] Queens Univ, Dept Pharmacol & Toxicol, Emergency Med, Kingston, ON K7L 3N6, Canada
[8] Queens Univ, Dept Pharmacol & Toxicol, Pharmacol & Toxicol, Kingston, ON K7L 3N6, Canada
[9] Univ Alberta, Dept Emergency Med, Edmonton, AB, Canada
[10] Univ Alberta, Dept Emergency Med, Emergency Med, Edmonton, AB, Canada
[11] Univ Laval, Dept Emergency Med, Quebec City, PQ G1K 7P4, Canada
[12] Univ Ottawa, Clin Epidemiol Program, Ottawa Hosp Res Inst, Ottawa, ON, Canada
[13] Univ British Columbia, Dept Emergency Med, Vancouver, BC V5Z 1M9, Canada
[14] McMaster Univ, Div Emergency Med, Hamilton, ON, Canada
[15] Univ Toronto, Div Emergency Med, Toronto, ON, Canada
[16] Univ Western Ontario, Div Emergency Med, London, ON, Canada
[17] Univ Manitoba, Dept Emergency Med, Winnipeg, MB, Canada
[18] Univ Ottawa, Div Neurosurg, Clin Epidemiol Program, Ottawa Hosp Res Inst,Consulting Neurosurg, Ottawa, ON, Canada
[19] Univ Ottawa, Dept Epidemiol & Community Med, Clin Epidemiol Program, Ottawa Hosp Res Ins,Biostat & Epidemiol, Ottawa, ON, Canada
来源
BMJ-BRITISH MEDICAL JOURNAL | 2011年 / 343卷
关键词
D O I
10.1136/bmj.d4277
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset. Design Prospective cohort study. Setting 11 tertiary care emergency departments across Canada, 2000-9. Participants Neurologically intact adults with a new acute headache peaking in intensity within one hour of onset in whom a computed tomography was ordered by the treating physician to rule out subarachnoid haemorrhage. Main outcome measures Subarachnoid haemorrhage was defined by any of subarachnoid blood on computed tomography, xanthochromia in cerebrospinal fluid, or any red blood cells in final tube of cerebrospinal fluid collected with positive results on cerebral angiography. Results Of the 3132 patients enrolled (mean age 45.1, 2571 (82.1%) with worst headache ever), 240 had subarachnoid haemorrhage (7.7%). The sensitivity of computed tomography overall for subarachnoid haemorrhage was 92.9% (95% confidence interval 89.0% to 95.5%), the specificity was 100% (99.9% to 100%), the negative predictive value was 99.4% (99.1% to 99.6%), and the positive predictive value was 100% (98.3% to 100%). For the 953 patients scanned within six hours of headache onset, all 121 patients with subarachnoid haemorrhage were identified by computed tomography, yielding a sensitivity of 100% (97.0% to 100.0%), specificity of 100% (99.5% to 100%), negative predictive value of 100% (99.5% to 100%), and positive predictive value of 100% (96.9% to 100%). Conclusion Modern third generation computed tomography is extremely sensitive in identifying subarachnoid haemorrhage when it is carried out within six hours of headache onset and interpreted by a qualified radiologist.
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