Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Township, Kaohsiung County 833, Taiwan.
Department of Emergency Medicine, Yunlin Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 1500, Gongye Rd., Mailiao Township, Yunlin County 638, Taiwan.
Am J Emerg Med. 2020 Feb;38(2):198-202. doi: 10.1016/j.ajem.2019.02.003. Epub 2019 Feb 7.
Subarachnoid hemorrhage (SAH) is a serious cause of headaches. The Ottawa subarachnoid hemorrhage (OSAH) rule helps identify SAH in patients with acute nontraumatic headache with high sensitivity, but provides limited information for identifying other intracranial pathology (ICP).
To assess the performance of the OSAH rule in emergency department (ED) headache patients and evaluate its impact on the diagnosis of intracranial hemorrhage (ICH) and other ICP.
We conducted a retrospective cohort study from January 2016 to March 2017. Patients with acute headache with onset within 14 days of the ED visit, were included. We excluded patients with head trauma that occurred in the previous 7 days, new onset of abnormal neurologic findings, or consciousness disturbance. According to the OSAH rule, patients with any included predictors required further investigation.
Of 913 patients were included, 15 of them were diagnosed with SAH. The OSAH rule had 100% (95% CI, 78.2%-100%) sensitivity and 37.0% (95% CI, 33.8-40.2%) specificity for identifying SAH. Twenty-two cases were identified as SAH or ICH with 100% sensitivity (95% CI, 84.6%-100%) and 37.3% (95% CI, 34.1%-40.5%) specificity. As for non-hemorrhagic ICP, both the sensitivity and negative predictive values (NPV) decreased to 75.0% (95% CI, 53.3%-90.2%) and 98.2% (95% CI, 96.1%-99.3%), respectively.
The OSAH rule had 100% sensitivity and NPV for diagnosing SAH and ICH with acute headache. The sensitivity and specificity were lower for non-hemorrhagic ICP. The OSAH rule may be an effective tool to exclude acute ICH and SAH in our setting.
蛛网膜下腔出血（SAH）是头痛的严重原因。渥太华蛛网膜下腔出血（OSAH）规则有助于识别具有高灵敏度的急性非创伤性头痛患者中的 SAH，但提供的信息有限，无法识别其他颅内病变（ICP）。
评估 OSAH 规则在急诊科（ED）头痛患者中的表现，并评估其对颅内出血（ICH）和其他 ICP 的诊断的影响。
我们进行了一项回顾性队列研究，时间为 2016 年 1 月至 2017 年 3 月。纳入的患者为 ED 就诊 14 天内出现急性头痛的患者。我们排除了过去 7 天内头部外伤、新发异常神经表现或意识障碍的患者。根据 OSAH 规则，任何包含的预测因子的患者都需要进一步检查。
共纳入 913 例患者，其中 15 例诊断为 SAH。OSAH 规则对 SAH 的识别具有 100%（95%CI，78.2%-100%）的敏感性和 37.0%（95%CI，33.8%-40.2%）的特异性。22 例患者被诊断为 SAH 或 ICH，具有 100%（95%CI，84.6%-100%）的敏感性和 37.3%（95%CI，34.1%-40.5%）的特异性。对于非出血性 ICP，敏感性和阴性预测值（NPV）均降至 75.0%（95%CI，53.3%-90.2%）和 98.2%（95%CI，96.1%-99.3%）。
OSAH 规则对急性头痛患者的 SAH 和 ICH 具有 100%的敏感性和 NPV。对于非出血性 ICP，敏感性和特异性较低。OSAH 规则可能是在我们的环境中排除急性 ICH 和 SAH 的有效工具。
