External validation of the Ottawa subarachnoid hemorrhage clinical decision rule in patients with acute headache

Bellolio, M. Fernanda; Hess, Erik P.; Gilani, Waqas I; VanDyck, Tyler; Ostby, Stuart A.; Schwarz, Jessica; Lohse, Christine M.; Rabinstein, Alejandro A.

doi:10.1016/j.ajem.2014.11.049

Cited by 32 publications

(30 citation statements)

References 14 publications

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“…Initial Imaging Given the morbidity and mortality of SAH from ruptured aneurysm and other causes of acute intracranial hemorrhage, imaging is often performed in patients presenting with a sudden, severe headache or "worst headache of life." The "Ottawa SAH rule" [25] and subsequent validations [26,27] are clinical inclusion and exclusion criteria that are 100% sensitive but only 15% specific. These tools were designed to not miss SAH in this patient population; however, they were not intended to independently diagnose SAH as the headache source.…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Headache

Whitehead

Cardenas

Corey

et al. 2019

Journal of the American College of Radiology

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Headache is one of the most common human afflictions. In most cases, headaches are benign and idiopathic, and resolve spontaneously or with minor therapeutic measures. Imaging is not required for many types of headaches. However, patients presenting with headaches in the setting of "red flags" such as head trauma, cancer, immunocompromised state, pregnancy, patients 50 years or older, related to activity or position, or with a corresponding neurological deficit, may benefit from CT, MRI, or noninvasive vascular imaging to identify a treatable cause. This publication addresses the initial imaging strategies for headaches associated with the following features: severe and sudden onset, optic disc edema, "red flags," migraine or tension-type, trigeminal autonomic origin, and chronic headaches with and without new or progressive features.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Headache

Whitehead

Cardenas

Corey

et al. 2019

Journal of the American College of Radiology

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“…This study found that the Ottawa SAH Rule had 100% sensitivity; however, it had a wide 95% CI (62.9%-100%). 19 We designed and conducted this prospective validation study according to the strict methodological standards for clinical decision rule development. [11][12][13][14] We carefully defined the outcome, subarachnoid hemorrhage, and it is clinically important.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache

2018

CMAJ

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“…From 66 unique citations identified using our search strategy, we found four relevant articles [3][4][5][6]. Across a total of 3317 patients enrolled from four countries in these studies, the Ottawa SAH rule had not missed a single case of SAH, with a pooled sensitivity of 100%.…”

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confidence: 99%

“…However, there appear to be a number of other factors which limits the use of the Ottawa SAH score. Most importantly, its specificity has been shown to be universally poor, with point estimates ranging from 7.6% [3] to 13.6% [5]. Physicians should be cautious not to investigate patients merely because they demonstrate one or more high risk features; in these circumstances, the score should act as a prompt to apply clinical judgement more keenly in formulating a clinical diagnosis of SAH.…”

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confidence: 99%

“…Secondly, the actual or potential reduction in investigation rate has been shown to be relatively modest at 4.7% by both Perry et al [5] and Chu et al [6]. Furthermore, Bellolio et al suggest that the rule can only be applied to a small proportion (9%) of the ED cohort [3]. Nevertheless, given the substantial rise in CT imaging rates in recent years [7], even modest reductions may accrue benefits for healthcare institutions.…”

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