Morgenstern L B, Luna-Gonzales H, Huber J C, Wong S S, Uthman M O, Gurian J H, Castillo P R, Shaw S G, Frankowski R F, Grotta J C
Department of Neurology, Epidemiology Research Center, University of Texas Medical School at Houston, 77030, USA.
Ann Emerg Med. 1998 Sep;32(3 Pt 1):297-304.
This study investigated the hypothesis that modern computed tomographic (CT) imaging is sufficient to exclude subarachnoid hemorrhage (SAH) in patients with severe headache.
All 38,730 adult patients who presented to Hermann Hospital in Houston, Texas, during a 16-month period were prospectively screened to detect those with "the worst headache of my life." Two neuroradiologists blinded to the study hypothesis interpreted the CT scans. Patients with negative scans underwent comprehensive cerebrospinal fluid (CSF) analysis including cell count in first and last tubes, visual and spectrophotometric detection of xanthochromia, and CSF D-dimer assay.
A chief complaint of headache was elicited in 455 patients, and 107 of these had "worst headache" and were enrolled in the study. CT-confirmed SAH was found in 18 of the 107 (17%). Only 2 patients (2.5%, 95% confidence interval, .3% to 8.8%) had SAH detected by CSF analysis among those with negative CT imaging result. CSF spectrophotometric detection was the most sensitive test for blood. Three patients with less than 6 red blood cells in tube 1 had positive spectrophotometric results, but in all 3, tube 4 was negative on spectrophotometric analysis, suggesting a high false-positive rate.
Modern CT imaging is sufficient to exclude 97.5% of SAH in patients presenting to the ED with "worst headache" symptoms.
本研究调查了以下假设，即现代计算机断层扫描（CT）成像足以排除重度头痛患者的蛛网膜下腔出血（SAH）。
在16个月的时间里，对所有前往德克萨斯州休斯顿赫尔曼医院就诊的38730名成年患者进行前瞻性筛查，以检测出那些患有“我一生中最严重的头痛”的患者。两名对研究假设不知情的神经放射科医生解读CT扫描结果。扫描结果为阴性的患者接受了全面的脑脊液（CSF）分析，包括第一管和最后一管的细胞计数、肉眼和分光光度法检测黄变以及脑脊液D - 二聚体检测。
455名患者主诉头痛，其中107名患有“最严重头痛”并纳入研究。107名患者中有18名（17%）经CT确诊为SAH。在CT成像结果为阴性的患者中，只有2名患者（2.5%，95%置信区间，0.3%至8.8%）通过脑脊液分析检测出SAH。脑脊液分光光度法检测是检测血液最敏感的方法。第一管红细胞少于6个的3名患者分光光度法检测结果为阳性，但在所有3名患者中，第4管分光光度分析为阴性，提示假阳性率较高。
现代CT成像足以排除97.5%以“最严重头痛”症状到急诊科就诊患者的SAH。
