Gee Christopher, Dawson Matthew, Bledsoe Joseph, Ledyard Holly, Phanthavady Thongphanh, Youngquist Scott, McGuire Trever, Madsen Troy
Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
J Emerg Med. 2012 Jul;43(1):13-8. doi: 10.1016/j.jemermed.2011.09.012. Epub 2012 Feb 10.
Subarachnoid hemorrhage (SAH) is a life-threatening condition considered in patients presenting to the emergency department (ED) with acute and severe-onset headache. Currently, the practice pattern for suspected SAH is to perform a non-contrasted computed tomography (CT) scan of the head, followed by lumbar puncture (LP) if the CT is negative. Newer-generation 16-slice CT scanners have been shown in one study to be very sensitive for SAH.
We sought to validate these findings at our institution by retrospectively analyzing the sensitivity of our 16-slice or better CT scanner and performing a bayesian analysis with the results.
We utilized ED electronic medical records and the Department of Neurosurgery research database to search for patients admitted from the ED with a diagnosis of SAH from January 1, 2005 to December 31, 2008. We found a total of 134 patients admitted with SAH during this time frame.
Average age was 53.8 years; 62% were female. Presenting complaint was headache in 57%, paresthesia or weakness in 7%, unresponsive in 10%, confusion or altered mental status in 5%, and "other" in 10%. Sensitivity of 16-slice or better CT scanner in our study was 131/134, or 97.8% (95% confidence interval 93.1-99.4%). No patient with a negative CT had a lesion requiring intervention.
Our study confirms the high sensitivity of 16-slice or better CT scanners for SAH. This calls into question the need for LP after negative head CT when 16-slice CT or better is used.
蛛网膜下腔出血（SAH）是一种危及生命的疾病，对于因急性剧烈头痛而到急诊科（ED）就诊的患者需考虑此病。目前，对于疑似SAH的诊疗模式是先进行头部非增强计算机断层扫描（CT），如果CT结果为阴性，则进行腰椎穿刺（LP）。一项研究表明，新一代16层CT扫描仪对SAH非常敏感。
我们试图通过回顾性分析我院16层及以上CT扫描仪的敏感性并对结果进行贝叶斯分析来验证这些发现。
我们利用ED电子病历和神经外科研究数据库，搜索2005年1月1日至2008年12月31日期间从ED收治的诊断为SAH的患者。在此期间，我们共发现134例SAH患者。
平均年龄为53.8岁；62%为女性。就诊主诉为头痛的占57%，感觉异常或无力的占7%，无反应的占10%，意识模糊或精神状态改变的占5%，“其他”的占10%。在我们的研究中，16层及以上CT扫描仪的敏感性为131/134，即97.8%（95%置信区间93.1 - 99.4%）。CT结果为阴性的患者中没有需要干预的病变。
我们的研究证实了16层及以上CT扫描仪对SAH具有高敏感性。这使得在使用16层CT或更先进的CT进行头部CT检查结果为阴性后是否需要进行LP受到质疑。
