Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

@article{Dubosh2016SensitivityOE,
  title={Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis},
  author={Nicole M. Dubosh and M. Fernanda Bellolio and Alejandro A. Rabinstein and J.A. Edlow},
  journal={Stroke},
  year={2016},
  volume={47},
  pages={750–755}
}
Background and Purpose— Emerging evidence demonstrating the high sensitivity of early brain computed tomography (CT) brings into question the necessity of always performing lumbar puncture after a negative CT in the diagnosis of spontaneous subarachnoid hemorrhage (SAH). Our objective was to determine the sensitivity of brain CT using modern scanners (16-slice technology or greater) when performed within 6 hours of headache onset to exclude SAH in neurologically intact patients. Methods— After… 
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References

SHOWING 1-10 OF 43 REFERENCES

Subarachnoid hemorrhage diagnosis: lumbar puncture is still needed when the computed tomography scan is normal.

Good sensitivity of CT scan reports for SAH when the scan was performed after < or = 12 hours of symptom onset is demonstrated, but additional real-time experience is needed to better define the potential risk of a missed SAH should this population not receive the customary lumbar puncture examination in the setting of a negative CT scan.

Determining the sensitivity of computed tomography scanning in early detection of subarachnoid hemorrhage.

CT scanning is excellent for diagnosing subarachnoid hemorrhage and it is demonstrated that in the first days after ictus a negative CT scan is sufficient to exclude SAH.

Does 16-detector computed tomography improve detection of non-traumatic subarachnoid hemorrhage in the Emergency Department?

Nontraumatic subarachnoid hemorrhage in the setting of negative cranial computed tomography results: external validation of a clinical and imaging prediction rule.

Time-Dependent Test Characteristics of Head Computed Tomography in Patients Suspected of Nontraumatic Subarachnoid Hemorrhage

In patients presenting with acute headache and a normal head CT ⩽6 hours after ictus, as interpreted by experienced neuroradiologists, there is no added value of CSF analysis.

Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging

The chance of finding a vascular lesion in a patient with CT-negative, LP-positive SAH was 43%, underlining the need for an adequate diagnostic workup and female gender was found to be predictive for detecting aascular lesion.

Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis.

Modern CT imaging is sufficient to exclude 97.5% of SAH in patients presenting to the ED with "worst headache" symptoms, and CSF spectrophotometric detection was the most sensitive test for blood.

Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage.

Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan?

In patients with sudden headache but normal CT a deferred lumbar puncture is necessary to rule out subarachnoid haemorrhage, even if CT is performed within 12 hours after the onset of symptoms.

Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study

Modern third generation computed tomography is extremely sensitive in identifying subarachnoid haemorrhage when it is carried out within six hours of headache onset and interpreted by a qualified radiologist.