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… Expand
View on Wolters Kluwer
ahajournals.org
69 Citations
Highly Influential Citations
1
Background Citations
8
Methods Citations
2
Results Citations
1

69 Citations

Citation Type

Citation Type

Determining the diagnostic utility of lumbar punctures in CT negative suspected subarachnoid hemorrhage: A Systematic Review and Meta-analysis.
TLDR
The current clinical workflow of an LP after a negative CT head for a patient presenting with a sudden onset severe headache is observed to have a high enough proportion to warrant its continued use despite the sensitivity of modern CT scanners of >97%. Expand
Assessment of diagnostic strategies based on risk stratification for aneurysmal subarachnoid hemorrhage: a retrospective chart review
  • C. Bianchi, F. Ageron, P. Carron
  • Medicine
  • European journal of emergency medicine : official journal of the European Society for Emergency Medicine
  • 2021
TLDR
Clinical risk stratification and CTA strategy are well-tolerated and effective for diagnosis of SAH, avoiding systematic use of lumbar puncture. Expand
External validation of a clinical decision rule and neuroimaging rule-out strategy for exclusion of subarachnoid haemorrhage in the emergency department: A prospective observational cohort study
TLDR
This study will aim to assess the test characteristics of both a CT brain up to 24h from presentation and the Ottawa SAH clinical decision rule. Expand
The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis spontaneous subarachnoid hemorrhage
TLDR
In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis, and assessment of ONSD in head CTs taken with spontaneousSAH suspicion may contribute to the diagnoses. Expand
Acute Headache in the Emergency Department: Is Lumbar Puncture Still Necessary to Rule Out Subarachnoid Hemorrhage?
TLDR
By applying the evidence-based criteria presented in this study, the emergency department APN can confidently rule out spontaneous subarachnoid hemorrhage and reduce patient risks from unnecessary invasive and costly testing. Expand
Subarachnoid haemorrhage rules in the decision for acute CT of the head: external validation in a UK cohort.
TLDR
The Ottawa SAH rule correctly identified all patients with SAH in this contemporary cohort and is a useful tool to aid in the decision for CT of the head in patients presenting with acute non-traumatic headache to the ED. Expand
Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double inversion recovery
TLDR
The DIR sequence was more reliable at identifying signal abnormalities in subacute SAH patients than the T2*-W and SWI sequence, and is suggested as a promising imaging technique for detecting hemorrhagic areas without considering the anatomical distribution of SAH. Expand
Excluding subarachnoid haemorrhage within 24 hours: to LP or not to LP?
TLDR
A normal head CT has a very high negative predictive value to exclude SAH when carried out within 24 hours from ictus provided a 3rd generation CT scanner is utilised, and the scan is reported by a neuroradiologist. Expand
Spectrophotometry of cerebrospinal fluid for xanthochromia is a sensitive and specific test for subarachnoid bleeding but adds little to computed tomography
TLDR
It is concluded that spectrophotometry of CSF for xanthochromia is a sensitive and specific test for diagnosing SAH, however, it seems that an initial CTC identifies almost all patients with SAH. Expand
The role of imaging in the management of non-traumatic subarachnoid hemorrhage: a practical review
TLDR
The role of imaging in the diagnosis and management of non-traumatic subarachnoid hemorrhage is understood, the clinical diagnostic and prognostic scales are described, and the role of CT scan, lumbar puncture, and MR, including angiography are described. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 43 REFERENCES
Subarachnoid hemorrhage diagnosis: lumbar puncture is still needed when the computed tomography scan is normal.
TLDR
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. Expand
Does 16-detector computed tomography improve detection of non-traumatic subarachnoid hemorrhage in the Emergency Department?
TLDR
Estimation of the sensitivity of 16-detector CT for the diagnosis of non-traumatic subarachnoid hemorrhage in the Emergency Department of an academic tertiary care hospital found 97% (95% confidence interval 84-100%). Expand
Determining the Sensitivity of Computed Tomography Scanning in Early Detection of Subarachnoid Hemorrhage
TLDR
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. Expand
Nontraumatic subarachnoid hemorrhage in the setting of negative cranial computed tomography results: external validation of a clinical and imaging prediction rule.
TLDR
The clinical rule demonstrated useful Bayesian test characteristics when retrospectively validated against this patient cohort and failed to identify 20% of subarachnoid hemorrhage patients with a negative cranial CT result. Expand
Time-Dependent Test Characteristics of Head Computed Tomography in Patients Suspected of Nontraumatic Subarachnoid Hemorrhage
TLDR
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. Expand
Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging
TLDR
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. Expand
Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis.
TLDR
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. Expand
Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage.
TLDR
Noncontrast CT imaging exhibits inadequate sensitivity to serve as a sole diagnostic modality in detecting spontaneous subarachnoid hemorrhage caused by aneurysm or arteriovenous malformation. Expand
Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan?
TLDR
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. Expand
Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study
TLDR
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. Expand
...
1
2
3
4
5
...