Impact of subarachnoid haemorrhage Canadian clinical decision rules for investigation of acute headache: a retrospective case note review

Yiangou, Andreas; Nikolenko, Nikoletta; Noreikaite, Jurate; Thondam, Sravan

doi:10.1016/s0140-6736(17)30499-3

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 Another UK study reported a similar CT investigation rate of 61.7% with the application of the Ottawa SAH rule, which was significantly higher than the rate of 54.2% in actual practice. 19 A review surmised that while the Ottawa SAH rule seemingly can rule out SAH, in actual practice, it might increase the frequency of CT investigations. 11 However, there is still a lack of impact analysis regarding the effects of the Ottawa SAH rule on patients' neurological outcomes and mortality.…”

Section: Discussionmentioning

confidence: 99%

Validation and modification of the Ottawa subarachnoid haemorrhage rule in risk stratification of Asian Chinese patients with acute headache

Cheung

Lui

Tsui³

2018

Hong Kong Med J

View full text Add to dashboard Cite

To validate the Ottawa subarachnoid haemorrhage (SAH) rule in an Asian Chinese cohort and to explore the roles of blood pressure and vomiting in prediction of SAH in patients with nontraumatic acute headache. Methods: A retrospective cohort study was conducted in two regional hospitals. All patients aged ≥16 years who presented with non-traumatic acute headache to the study centres from July 2013 to June 2016 were included. A logistic regression model was created for the variables of the Ottawa SAH rule and other potential predictors, including vomiting and systolic blood pressure (SBP) >160 mm Hg. Model discrimination was evaluated using the area under the receiver operating characteristic curve. Net reclassification improvement and integrated discrimination improvement indices were evaluated. The model's diagnostic characteristics, including sensitivities and specificities, were evaluated. Results: A total of 500 eligible headache cases were included, in 50 of which SAH was confirmed (10%). In addition to the predictors of the Ottawa SAH rule, vomiting and SBP >160 mm Hg were found to be significant independent predictors of SAH.

show abstract

Section: Discussionmentioning

confidence: 99%

Validation and modification of the Ottawa subarachnoid haemorrhage rule in risk stratification of Asian Chinese patients with acute headache

Cheung

Lui

Tsui³

2018

Hong Kong Med J

View full text Add to dashboard Cite

show abstract

“…Thirteen studies assessed the clinical decision rules developed by Perry et al for screening patients according to the presence of clinical characteristics associated with a high risk of SAH 13–25. The predecessors of the Ottawa SAH Rule (sometimes termed the ‘Canadian clinical decision rules 1, 2 and 3’) were evaluated in six studies.…”

Section: Resultsmentioning

confidence: 99%

Management of patients presenting to the emergency department with sudden onset severe headache: systematic review of diagnostic accuracy studies

et al. 2022

View full text Add to dashboard Cite

ObjectiveAdvances in imaging technologies have precipitated uncertainty and inconsistency in the management of neurologically intact patients presenting to the Emergency Department (ED) with non-traumatic sudden onset severe headache with a clinical suspicion of subarachnoid haemorrhage (SAH). The objective of this systematic review was to evaluate diagnostic strategies in these patients.MethodsStudies assessing any decision rule or diagnostic test for evaluating neurologically intact adults with a severe headache, reaching maximum intensity within 1 hour, were eligible. Eighteen databases (including MEDLINE and Embase) were searched. Quality was assessed using QUADAS-2. Where appropriate, hierarchical bivariate meta-analysis was used to synthesise diagnostic accuracy results.ResultsThirty-seven studies were included. Eight studies assessing the Ottawa SAH clinical decision rule were pooled; sensitivity 99.5% (95% CI 90.8 to 100), specificity 24% (95% CI 15.5 to 34.4). Four studies assessing CT within 6 hours of headache onset were pooled; sensitivity 98.7% (95% CI 96.5 to 100), specificity 100% (95% CI 99.7 to 100). The sensitivity of CT beyond 6 hours was considerably lower (≤90%; 2 studies). Three studies assessing lumbar puncture (LP; spectrophotometric analysis) following negative CT were pooled; sensitivity 100% (95% CI 100 to 100), specificity 95% (95% CI 86.0 to 98.5).ConclusionThe Ottawa SAH Rule rules out further investigation in only a small proportion of patients. CT undertaken within 6 hours (with expertise of a neuroradiologist or radiologist who routinely interprets brain images) is highly accurate and likely to be sufficient to rule out SAH; CT beyond 6 hours is much less sensitive. The CT–LP pathway is highly sensitive for detecting SAH and some alternative diagnoses, although LP results in some false positive results.

show abstract

“…The potential impact of the Ottawa rule on neuroimaging rates is analysed in Fig 1. In total, there were eight studies that included rates of CT of the head in the original patient population and the potential rate of CT of the head if the Ottawa rule was applied. This included the external validation studies discussed earlier and two other studies from Matloob et al and Yiangou et al 20,21 These authors analysed an earlier version of the Ottawa rule and so the increase in CT rates in these studies is not exact but indicative only. There was an increase in the need for CT of the head following the application of the Ottawa rule in five of the eight studies, ranging from <1% to 100%.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid haemorrhage rules in the decision for acute CT of the head: external validation in a UK cohort

et al. 2021

View full text Add to dashboard Cite

Background The Ottawa subarachnoid haemorrhage (SAH) rule and the Emerald SAH rule are clinical decision tools to aid in the decision for computed tomography (CT) of the head in patients attending an emergency department (ED) with acute non-traumatic headache. The objective of this study was to analyse the performance of these rules in a contemporary UK cohort. Methods We performed a retrospective external validation study. Patients undergoing CT of the head for the evaluation and treatment of non-traumatic headaches over a 6-month period in the ED at two tertiary centres were assessed. Each patient's Ottawa rule and Emerald rule were calculated and compared with their final diagnosis. Results The cohort consisted of 366 patients and there were 16 cases of SAH (based on CT findings or the presence of xanthochromia in cerebrospinal fluid). The Ottawa rule identified 288 patients requiring CT of the head. The sensitivity of the Ottawa rule was 100% (95% confidence interval (CI) 71-100%) and the specificity was 22% (95% CI 18-27%). The Emerald rule identified 267 patients who required CT, and achieved a sensitivity of 81% (95% CI 54-96%) and a specificity of 27% (95% CI 23-32%). Conclusions The Ottawa SAH rule correctly identified all patients with SAH in this contemporary cohort. The Emerald rule did not perform as well in this cohort and is unsuitable for clinical use. The Ottawa rule is a useful tool to aid in the decision for CT of the head in patients presenting with acute non-traumatic headache to the ED.

show abstract

Impact of subarachnoid haemorrhage Canadian clinical decision rules for investigation of acute headache: a retrospective case note review

Cited by 3 publications

References 0 publications

Validation and modification of the Ottawa subarachnoid haemorrhage rule in risk stratification of Asian Chinese patients with acute headache

Validation and modification of the Ottawa subarachnoid haemorrhage rule in risk stratification of Asian Chinese patients with acute headache

Management of patients presenting to the emergency department with sudden onset severe headache: systematic review of diagnostic accuracy studies

Subarachnoid haemorrhage rules in the decision for acute CT of the head: external validation in a UK cohort

Contact Info

Product

Resources

About