Cost-effectiveness analysis of CTA and LP for evaluation of suspected SAH after negative non-contrast CT

Wu, Xiao; Kalra, Vivek B.; Forman, Howard P.

doi:10.1016/j.clineuro.2015.12.021

Cited by 6 publications

(2 citation statements)

References 27 publications

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“…Management of patients with thunderclap headache and the utility/effectiveness of CTA versus lumbar puncture after negative findings on a CT of the head study are areas of active debate. [14][15][16] Unfortunately, the legal case summaries did not provide adequate details to analyze these issues further in this study.…”

Section: Discussionmentioning

confidence: 99%

Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms

Khan¹,

Khunte²,

et al. 2023

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes. MATERIALS AND METHODS:We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm.RESULTS: Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively).CONCLUSIONS: Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers.

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Section: Discussionmentioning

confidence: 99%

Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms

Khan¹,

Khunte²,

et al. 2023

AJNR Am J Neuroradiol

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“…The investigation method is probably not cost-effective. 15 If, in reality, only 1/100 evaluated for acute headache actually has SAH, and over 90% of these will be detected with a conventional CT, one must order a minimum of 991 CTA to detect one additional aneurysm bleeding. Of these, around 20 (2%) will have a randomly detected aneurysm.…”

Section: Post Contrast T1-weighted Mri (Picture In the Middle) Shows mentioning

confidence: 99%

What is Currently the Best Investigational Approach to the Patient With Sudden‐Onset Severe Headache?

Sjulstad

Alstadhaug

2019

Headache

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A 48-year-old man with no previous medical history suddenly experienced severe intense retro-bulbar pain of pulsating character on the right side, and was seen in the emergency department 7 hours later. He was then alert and oriented, but in excruciating pain. There was no neck stiffness and no fever. The blood pressure was 141/80 mm Hg, and the pulse regular with a frequency of 48. Neurological examination was normal. Query by Dr. Sjulstad: When does actually sudden-onset severe headache represent a potential life-threatening condition?Response by Dr. Alstadhaug: There is no definite answer to that question. Atypical presentation of subarachnoid hemorrhage (SAH) with mild, or slowly progressive headache over minutes, and even absence of headache may occur in up to 3.8% of patients as reported in a recent Japanese study, 1 but previously up to 10% has been reported. 2 In a case series with 42 patients who had bled from an aneurysm, the headache came instantly in 50%, after 2-60 seconds in 24%, and within 1-5 minutes in 19%. 3 In 10%-40% of patients with diagnosed bleeding from an aneurysm, there has been an episode with hyperacute headache prior to the one that led to the diagnosis. 4 Such a warning leak has typically been reported to occur a couple of weeks earlier, but the risk of re-bleeding after SAH is highest within the first 24 hours. Non-ruptured aneurysms may also cause headache (dissection in the aneurysm wall, acute expansion or thrombosis), but more often they cause focal symptoms/signs due to mass effect Headache

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Charting the Next Road Map for CSF Biomarkers in Alzheimer's Disease and Related Dementias

Nayyar

Kaluzová

2023

Neurotherapeutics

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Cost-effectiveness analysis of CTA and LP for evaluation of suspected SAH after negative non-contrast CT

Cited by 6 publications

References 27 publications

Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms

Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms

What is Currently the Best Investigational Approach to the Patient With Sudden‐Onset Severe Headache?

Charting the Next Road Map for CSF Biomarkers in Alzheimer's Disease and Related Dementias

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