Division of Emergency Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
CJEM. 2002 Sep;4(5):333-7. doi: 10.1017/s1481803500007739.
This study evaluated the incidence of subarachnoid hemorrhage (SAH) and the use of computed tomography (CT) and lumbar puncture (LP) in a cohort of emergency department (ED) patients with acute headache.
Health records from a tertiary care ED were used to identify all patients over 15 years of age who presented with headache over a 10-month period. Patients were excluded if they had been referred with confirmed SAH or if they had recurrent headache, head trauma, decreased level of consciousness or new neurologic deficits. Outcome measures included ED diagnosis, use of CT or LP, and ED length of stay. Analysis included descriptive statistics, 95% confidence intervals (CIs) and analysis of variance for length of stay.
The mean age of the 891 patients was 41.9 years. Ten (1.1%) of the patients had SAH, 313 (35.1%) underwent CT, and 85 (9.5%) underwent LP. Only 9 (2.9%) of the CT scans and 2 (2.4%) of the LPs were positive for SAH. Of the 296 patients with normal CT results, 232 (78.4%) did not undergo subsequent LP. The mean length of stay was 4.0 hours (95% CI, 3.8-4.1) if no diagnostic testing was performed, 5.0 hours (95% CI, 4.7-5.4) if CT was performed and 7.1 hours (95% CI, 6.3-7.9) if LP was performed (p = 0.001).
Diagnostic testing was associated with substantially prolonged lengths of stay. CT and LP had low diagnostic yields, which suggests the need for a clinical decision rule to rule out SAH in ED patients with acute headache.
本研究评估了在一组因急性头痛就诊于急诊科的患者中蛛网膜下腔出血（SAH）的发生率，以及计算机断层扫描（CT）和腰椎穿刺（LP）的使用情况。
使用三级保健急诊科的健康记录来确定在 10 个月期间出现头痛的所有 15 岁以上患者。如果患者已经被确诊为 SAH 或头痛反复发作、头部外伤、意识水平下降或出现新的神经功能缺损，则将其排除在外。结局指标包括急诊科诊断、CT 或 LP 的使用情况以及急诊科住院时间。分析包括描述性统计、95%置信区间（CI）和住院时间的方差分析。
891 例患者的平均年龄为 41.9 岁。10 例（1.1%）患者有 SAH，313 例（35.1%）行 CT 检查，85 例（9.5%）行 LP。只有 9 例（2.9%）CT 扫描和 2 例（2.4%）LP 阳性结果提示 SAH。在 296 例 CT 结果正常的患者中，232 例（78.4%）未行进一步 LP。如果不进行诊断性检查，平均住院时间为 4.0 小时（95%CI，3.8-4.1）；如果进行 CT 检查，平均住院时间为 5.0 小时（95%CI，4.7-5.4）；如果进行 LP 检查，平均住院时间为 7.1 小时（95%CI，6.3-7.9）（p = 0.001）。
诊断性检查与显著延长的住院时间相关。CT 和 LP 的诊断率较低，这表明需要制定一个临床决策规则，以排除 ED 急性头痛患者的 SAH。
