Department of Emergency Medicine, Adana City Training and Research Hospital, Mithat Ozhan Avenue, 01370, Yuregir, Adana, Turkey.
Department of Neurosurgery, Kilis State Hospital, Kilis, Turkey.
Ir J Med Sci. 2023 Jun;192(3):1453-1462. doi: 10.1007/s11845-022-03106-7. Epub 2022 Jul 25.
Subarachnoid haemorrhage (SAH) clinical decision rules can provide successful results in the differential diagnosis of non-traumatic headache.
The aim of this study is to investigate whether a laboratory parameter that can be added to clinical decision-making rules can better predict subarachnoid haemorrhages in patients presenting to the emergency department with headache.
We conducted a retrospective cohort study between March 2017 and March 2019. Patients over the age of 18 who admitted to the emergency department with non-traumatic, acute headache last 14 days before admission and evaluated by imaging and laboratory studies were included in the study.
A total of 867 patients were included and 141 of them had SAH. In detecting the SAH, Ottawa SAH rule sensitivity (85.1%), specificity (47.1%), positive predictive value (PPV) (23.8%) and negative predictive value (NPV) (94.2%), and for EMERALD SAH, rule sensitivity (96.4%), specificity (43.2%), PPV (24.8%) and NPV (98.4%). In the regression analysis, statistically significant result was obtained to exclude the diagnosis of SAH with the decrease in the eosinophil value (cutoff < 0.085 10^3/µL, OR: 0.011, 95% CI: 0.001-0.213, p = 0.003). When eosinophil value was added to EMERALD SAH rule, it provided a 100% of sensitivity, a 38.4% of specificity, a 24% of PPV and a 100% of NPV in detecting the SAH.
EMERALD SAH rule plus eosinophil, which offers 100% sensitivity and NPV for predicting SAH in adult non-traumatic headaches, may be recommended as a successful and practical decision rule for clinical use according to the Ottawa and EMERALD SAH rule.
蛛网膜下腔出血（SAH）临床决策规则可在非创伤性头痛的鉴别诊断中提供成功的结果。
本研究旨在探讨是否可以添加实验室参数来改善临床决策规则，以更好地预测因非创伤性、急性头痛就诊于急诊科的患者发生蛛网膜下腔出血的情况。
我们进行了一项回顾性队列研究，时间为 2017 年 3 月至 2019 年 3 月。纳入标准为年龄>18 岁，入院前 14 天内因非创伤性、急性头痛就诊于急诊科，且接受了影像学和实验室检查的患者。
共纳入 867 例患者，其中 141 例患者存在蛛网膜下腔出血。在检测蛛网膜下腔出血方面，渥太华 SAH 规则的敏感性为 85.1%，特异性为 47.1%，阳性预测值为 23.8%，阴性预测值为 94.2%；而 EMERALD SAH 规则的敏感性为 96.4%，特异性为 43.2%，阳性预测值为 24.8%，阴性预测值为 98.4%。回归分析显示，嗜酸性粒细胞值降低（截断值<0.085×10^3/μL，OR：0.011，95%CI：0.001-0.213，p=0.003）可显著排除 SAH 诊断。当将嗜酸性粒细胞值添加到 EMERALD SAH 规则中时，该规则在检测蛛网膜下腔出血方面的敏感性为 100%，特异性为 38.4%，阳性预测值为 24%，阴性预测值为 100%。
EMERALD SAH 规则联合嗜酸性粒细胞可提供 100%的敏感性和阴性预测值，有助于预测成人非创伤性头痛患者的蛛网膜下腔出血，可能可作为一种成功且实用的临床决策规则，优于渥太华和 EMERALD SAH 规则。
