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Sensitivity of modern multislice CT for subarachnoid haemorrhage at incremental timepoints after headache onset: a 10-year analysis
  1. Annabel Vincent1,
  2. Scott Pearson1,
  3. John W Pickering1,2,
  4. James Weaver1,
  5. Leanne Toney1,
  6. Laura Hamill1,
  7. Michael Hurrell3,
  8. Martin Than1
  1. 1 Christchurch Hospital Emergency Department, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
  2. 2 Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
  3. 3 Christchurch Hospital Radiology Department, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
  1. Correspondence to Dr Martin Than, Christchurch Hospital Emergency Department, Canterbury District Health Board, Christchurch 8140, Canterbury, New Zealand; martin{at}thanstedman.onmicrosoft.com

Abstract

Background CT performed within 6 hours of headache onset is highly sensitive for the detection of subarachnoid haemorrhage (SAH). Beyond this time frame, if the CT is negative for blood, a lumbar puncture is often performed. Technology improvements in image noise reduction, resolution and motion artefact have enhanced the performance of multislice CT (MSCT) and may have further improved sensitivity. We aimed to describe how the sensitivity to SAH of modern MSCT changes with time from headache onset.

Methods This was a retrospective analysis of electronic data collected as part of routine care among all patients presenting to Christchurch Hospital diagnosed with a SAH between 1 January 2008 and 31 December 2017. Patients were imaged with MSCT. The primary outcome was the proportion of patients with spontaneous aneurysmal SAH (identified via coding and confirmed by clinical and radiological records) that had a positive MSCT. The secondary outcome was the proportion of patients with any type of spontaneous SAH that had a positive MSCT.

Results There were 347 patients with an SAH of whom 260 were aneurysmal SAH. MSCT identified 253 (97.3%) of all aneurysmal SAH and 332 (95.7%) of all SAH. The sensitivity of MSCT was 99.6% (95% CI 97.6 to 100) for aneurysmal SAH and 99.0% (95% CI 97.1 to 99.8) for all SAH at 48 hours after headache onset. At 24 hours after headache onset, the sensitivity for aneurysmal SAH was 100% (95% CI 98.3 to 100).

Conclusion These data suggest that it may be possible to extend the timeframe from headache onset within which modern MSCT can be used to rule out aneurysmal SAH.

  • headache
  • emergency department

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Handling editor Edward Carlton

  • Twitter @kiwiskiNZ

  • AV and SP contributed equally.

  • Contributors Study conception: SP and MT. Data collection: AV and SP. Data analysis: JP, SP, MT, JW, LH and AV. Interpretation: SP, JP, MT, JW, LH, MH and LT. Manuscript writing: SP, JP, MT, JW, MH and LH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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