High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study

Perry et al identify the clinical characteristics that are sensitive and reliable enough to combine into a clinical decision rule to rule out subarachnoid hemorrhage in neurologically intact emergency patients with acute headache. They derived three related clinical decision models, based on recursi...

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Bibliographic Details
Published in:BMJ 2010-11, Vol.341 (nov05 1), p.c6255-c6255
Main Authors: Perry, Jeffrey J, Stiell, Ian G, Sivilotti, Marco L A, Bullard, Michael J, Lee, Jacques S, Eisenhauer, Mary, Symington, Cheryl, Mortensen, Melodie, Sutherland, Jane, Lesiuk, Howard, Wells, George A
Format: Article
Language:English
Subjects:
Fainting
Headaches
Hemorrhage
Hypertension
Neck pain
Vomiting
Online Access:Get full text
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Summary:Perry et al identify the clinical characteristics that are sensitive and reliable enough to combine into a clinical decision rule to rule out subarachnoid hemorrhage in neurologically intact emergency patients with acute headache. They derived three related clinical decision models, based on recursive partitioning and using only highly reliable variables. All three rules have retrospective sensitivity of 100%. The specificity of the models ranged from 28.4% to 38.8%, with corresponding investigation rates from 63.7% to 73.5%, lower than the observed rate of 82.9%. Age 40 and over, arrival by ambulance, onset with exertion, complaint of neck stiffness or pain, raised blood pressure, loss of consciousness, or vomiting are predictive for subarachnoid hemorrhage.
ISSN:0959-8138
1756-1833
0959-8146
1468-5833
1756-1833
DOI:10.1136/bmj.c6255