Byyny Richard L, Mower William R, Shum Natalie, Gabayan Gelareh Z, Fang Shanna, Baraff Larry J
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
Ann Emerg Med. 2008 Jun;51(6):697-703. doi: 10.1016/j.annemergmed.2007.10.007. Epub 2008 Jan 22.
Emergency physicians use noncontrast cranial computed tomographic (CT) imaging of headache patients to identify subarachnoid hemorrhage caused by aneurysms or arteriovenous malformations. Given sufficiently high sensitivity, CT imaging could be used as a definitive diagnostic study in these patients. The purpose of this study is to determine the sensitivity of noncontrast cranial CT in detecting all spontaneous subarachnoid hemorrhages and those caused by aneurysm or arteriovenous malformation.
This was a retrospective review performed at an urban tertiary academic emergency department (ED). Using a combination of noncontrast cranial CT radiology coding, lumbar puncture results, International Classification of Diseases, Ninth Revision discharge diagnosis, and medical record review, we identified all patients who presented to a tertiary care academic ED from August 1, 2001, to December 31, 2004, with spontaneous subarachnoid hemorrhage. We determined whether patients were diagnosed by cranial CT or lumbar puncture, the presence of headache and level of consciousness at ED presentation, and whether or not they had an aneurysm or arteriovenous malformation.
We identified 149 patients who were diagnosed with spontaneous subarachnoid hemorrhage during the study period. Noncontrast cranial CT scan diagnosed 139 patients, and 10 were diagnosed with lumbar puncture. This yielded an overall CT scan sensitivity of 93% (95% confidence interval [CI] 88% to 97%). Of the 149 with subarachnoid hemorrhage, 117 (79%) had aneurysm or arteriovenous malformation; cranial CT scan demonstrated subarachnoid hemorrhage in 110 of the 117, for a sensitivity of 94% (95% CI 88% to 98%). For the 67 patients presenting with headache and normal mental status who had a subarachnoid hemorrhage and vascular lesions (either aneurysm or arteriovenous malformation), the sensitivity of cranial CT scan was 91% (95% CI 82% to 97%).
Noncontrast CT imaging exhibits inadequate sensitivity to serve as a sole diagnostic modality in detecting spontaneous subarachnoid hemorrhage caused by aneurysm or arteriovenous malformation.
急诊医师对头痛患者进行头颅非增强计算机断层扫描（CT）成像，以识别由动脉瘤或动静脉畸形引起的蛛网膜下腔出血。鉴于其具有足够高的敏感性，CT成像可作为这些患者的确定性诊断检查。本研究的目的是确定头颅非增强CT在检测所有自发性蛛网膜下腔出血以及由动脉瘤或动静脉畸形引起的蛛网膜下腔出血方面的敏感性。
这是在一家城市三级学术急诊科（ED）进行的回顾性研究。通过结合头颅非增强CT放射学编码、腰椎穿刺结果、国际疾病分类第九版出院诊断以及病历审查，我们确定了2001年8月1日至2004年12月31日期间所有因自发性蛛网膜下腔出血就诊于三级医疗学术急诊科的患者。我们确定患者是否通过头颅CT或腰椎穿刺确诊，在急诊科就诊时是否存在头痛及意识水平，以及他们是否患有动脉瘤或动静脉畸形。
我们识别出149例在研究期间被诊断为自发性蛛网膜下腔出血的患者。头颅非增强CT扫描诊断出139例患者，10例通过腰椎穿刺确诊。这使得CT扫描的总体敏感性为93%（95%置信区间[CI]88%至97%）。在149例蛛网膜下腔出血患者中，117例（79%）患有动脉瘤或动静脉畸形；头颅CT扫描在117例中的110例显示有蛛网膜下腔出血，敏感性为94%（95%CI 88%至98%）。对于67例出现头痛且精神状态正常、患有蛛网膜下腔出血和血管病变（动脉瘤或动静脉畸形）的患者，头颅CT扫描的敏感性为91%（95%CI 82%至97%）。
头颅非增强CT成像在检测由动脉瘤或动静脉畸形引起的自发性蛛网膜下腔出血时，作为唯一诊断方式的敏感性不足。
