The Ottawa subarachnoid hemorrhage clinical decision rule for classifying emergency department headache patients

Wu, Woei-Cherng; Pan, Hsiu-Yung; Wu, Keng‐Liang; Huang, Yufei; Wu, Chien-Hung; Cheng, Fu-Jen

doi:10.1016/j.ajem.2019.02.003

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…For these patients with an onset of severe headache presenting within minutes, swift access to cranial CT imaging is critical to avoid missing this life-threatening disease. To select patients at risk of subarachnoid hemorrhage, physicians can rely on clinical risk scores, such as the Ottawa SAH rules ( 26 ). Furthermore, we must underline the fact that a considerable number of secondary headache etiologies (infectious disease, increased or decreased intracranial pressure, and subarachnoid hemorrhage >6 h after onset) are not apparent on cranial CT.…”

Section: Discussionmentioning

confidence: 99%

“…A prospective study in patients with non-traumatic headache should be performed to determine specific patient characteristics related with secondary (severe) headache disorders. Previous literature has provided several clinical prediction tools (based on retrospective data) to determine patients' risk of intracranial pathology, which should be externally validated and optimized in different patient populations ( 19 , 24 , 26 ). Evidence-based clinical tools will provide clear diagnostic guidelines for ED clinicians in performing cranial CT in headache patients, which may reduce unnecessary additional imaging and thus healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

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The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

2021

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Background: Headache is among the most prevalent complaints in patients presenting to the emergency department (ED). Clinicians are faced with the difficult task to differentiate primary (benign) from secondary headache disorders, since no international guidelines currently exist of clinical indicators for neuroimaging in headache patients.Methods: We performed a retrospective review of 501 patients who presented at the ED with headache as a primary complaint between April 2018 and December 2018. Primary outcomes included the amount of diagnostic imaging, the different conclusions provided by diagnostic imaging, and the clinical factors associated with abnormal imaging results.Results: About half of the patients were diagnosed with a primary headache disorder. Cranial CT imaging at the ED was performed regularly (61% of the patients) and led to the diagnosis of underlying pathology in 1 in 7.6 patients. In a multivariate model, factors significantly associated with abnormal cranial CT results were age 50 years or older, presentation within 1 h after headache onset, clinical history of aphasia, and focal neurological deficit at examination.Conclusions: As separate clinical characteristics have limited value in detecting severe underlying headache disorders, cranial imaging is regularly performed in the ED. Clinical prediction model tools applied to headache patients may identify patients at risk of intracranial pathology prior to diagnostic imaging and reduce cranial imaging in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

2021

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“…Their study showed that implementing both rules decreased the need for testing and hospital admissions ( p < 0.0001 and p < 0.011, respectively) [ 11 ]. Wu et al and Bellolio et al drew similar conclusions regarding sensitivity [ 17 , 18 ]. Furthermore, lumbar puncture (LP) or CT angiography use was decreased as a result of the utilization of the 6-h CT rule and the Ottawa rule ( p < 0.0001) [ 11 ].…”

Section: Discussionmentioning

confidence: 81%

Subarachnoid hemorrhage in the emergency department

2021

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Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

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“…Nearly half of our patients with ICH presented with headache, either alone or accompanied with other symptoms such as altered mental status. There is little debate that new neurologic deficits require imaging in the ED, but in the general population, judicious use of imaging to evaluate headache is recommended using clinical decision tools such as the Canadian computed tomography head rule or the Ottawa subarachnoid hemorrhage [15,16]. In the cancer population, such screening is not validated, and the frequency of ICH in patients presenting with non-focal symptoms such as headache or altered mental status makes bypassing imaging risky.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

Qdaisat

Yeung

Hernandez

et al. 2022

JCM

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Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment. To evaluate the characteristics and clinical outcomes of cancer patients with ICH, we identified all patients with ICH who visited The University of Texas MD Anderson Cancer Center emergency department between 1 September 2006 and 16 February 2016. Clinical and radiologic data were collected and compared. Logistic regression analyses were used to determine the association between clinical variables and various outcomes. During the period studied, 704 confirmed acute ICH cases were identified. In-hospital, 7-day, and 30-day mortality rates were 15.1, 11.4, and 25.6%, respectively. Hypertension was most predictive of intensive care unit admission (OR = 1.52, 95% CI = 1.09–2.12, p = 0.013). Low platelet count was associated with both in-hospital mortality (OR = 0.96, 95% CI = 0.94–0.99, p = 0.008) and 30-day mortality (OR = 0.98, 95% CI = 0.96–1.00, p = 0.016). Radiologic findings, especially herniation and hydrocephalus, were strong predictors of short-term mortality. Among known risk factors of ICH, those most helpful in predicting cancer patient outcomes were hypertension, low platelet count, and the presence of hydrocephalus or herniation. Understanding how the clinical presentation, risk factors, and imaging findings correlate with patient morbidity and mortality is helpful in guiding the diagnostic evaluation and aggressiveness of care for ICH in cancer patients.

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The Ottawa subarachnoid hemorrhage clinical decision rule for classifying emergency department headache patients

Cited by 9 publications

References 22 publications

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

Subarachnoid hemorrhage in the emergency department

Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

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