What Are the Unintended Consequences of Changing the Diagnostic Paradigm for Subarachnoid Hemorrhage After Brain Computed Tomography to Computed Tomographic Angiography in Place of Lumbar Puncture?

Edlow, Jonathan A.

doi:10.1111/j.1553-2712.2010.00840.x

Cited by 32 publications

(12 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,7 Differences in practice could be partially explained by the variety of different diagnostic approaches in the literature especially for suspected SAH. 8,9 Additionally, the benign nature of the vast majority of headaches limits rigorous comparisons of alternative diagnostic workups for infrequent lifethreatening causes due to the large sample sizes required.…”

Section: Discussionmentioning

confidence: 99%

Acute Headache Presentations to the Emergency Department: A Statewide Cross‐sectional Study

Chu

Howell

Keijzers

et al. 2017

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergency department (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined.Methods: A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined.Results: There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was "worst ever" in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography (CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and "primary headache not further specified" in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional

show abstract

Section: Discussionmentioning

confidence: 99%

Acute Headache Presentations to the Emergency Department: A Statewide Cross‐sectional Study

Chu

Howell

Keijzers

et al. 2017

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Apart from obvious issues of diagnostic accuracy, evidence is mounting about the long-term consequences of increasing radiation exposure [105]. Furthermore, incidental findings drive further investigations, which may lead to adverse consequences [106]. …”

Section: Discussionmentioning

confidence: 99%

Avoiding Misdiagnosis in Patients with Neurological Emergencies

Pope

Edlow

2012

Emergency Medicine International

Self Cite

View full text Add to dashboard Cite

Approximately 5% of patients presenting to emergency departments have neurological symptoms. The most common symptoms or diagnoses include headache, dizziness, back pain, weakness, and seizure disorder. Little is known about the actual misdiagnosis of these patients, which can have disastrous consequences for both the patients and the physicians. This paper reviews the existing literature about the misdiagnosis of neurological emergencies and analyzes the reason behind the misdiagnosis by specific presenting complaint. Our goal is to help emergency physicians and other providers reduce diagnostic error, understand how these errors are made, and improve patient care.

show abstract

“…Lumbar Puncture (LP) is considered effectively 100% sensitive for detection of blood in the subarachnoid space, and it is recommended in all patients undergoing a workup for SAH with a negative CT[132–134]. CSF characteristics of SAH include an elevated opening pressure, presence of erythrocytes or red blood cells (RBCs), and xanthochromia.…”

Section: Lumbar Puncturementioning

confidence: 99%