Should spectrophotometry be used to identify xanthochromia in the cerebrospinal fluid of alert patients suspected of having subarachnoid hemorrhage?
Should spectrophotometry be used to identify xanthochromia in the cerebrospinal fluid of alert patients suspected of having subarachnoid hemorrhage?
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DOI：
10.1161/01.str.0000240689.15109.47
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发表时间：
2006-10-01
期刊：
影响因子：
8.3
通讯作者：
Symington, Cheryl
中科院分区：
文献类型：
--
作者：
Perry, Jeffrey J.;Sivilotti, Marco L. A.;Symington, Cheryl
背景和目的：脑脊液（CSF）中无黄色素常被用来排除蛛网膜下腔出血（SAH）。权威人士提倡用分光光度法来测量黄色素，但大多数北美医院都使用目视检查。我们研究了分光光度法诊断SAH的准确性，其对当前practice. Methods的潜在影响，这是一个前瞻性队列研究比较诊断准确性的测试。该研究在3所大学附属的三级急诊科进行。我们招募了连续的神经系统完整的成人非创伤性头痛进行腰椎穿刺（LP），以排除SAH。将CSF离心、冷冻并随后分批分析。SAH的定义为：（1）CT显示蛛网膜下腔出血，（2）最终CSF管中红细胞数> 5 × 10（6）个/L且血管造影阳性，或（3）CSF中可见黄色素沉着且血管造影阳性。所有缺乏正常CT和LP的受试者在30 day.Results-We招募了220例患者（平均年龄42-16岁; CT率87.7%;血管造影率5.9%）。确定了两种SAH：I例CSF中红细胞无黄染，I例CSF中可见黄染。目视检查黄色素沉着的特异性为97%（95%CI：92%至99%），但2种分光光度定义的特异性低至29%（95%CI：23%至35%）。引入分光光度法可能导致血管造影在多达11%至71%的患者接受LP. Conclusions分光光度法的定义黄色素只有中度至低度特异性SAH。使用分光光度法可能会增加血管造影率，从而识别出更多的偶发动脉瘤，增加患者焦虑，并使患者暴露于不必要的手术或研究并发症中，但没有获益。
Background and Purpose-The absence of xanthochromia in the cerebrospinal fluid (CSF) is often used to exclude subarachnoid hemorrhage (SAH). Authorities advocate spectrophotometry to measure xanthochromia, but most North American hospitals use visual inspection. We studied the diagnostic accuracy of spectrophotometry for SAH, and its potential impact on current practice.Methods-This was a prospective cohort study comparing the diagnostic accuracy of tests. The study was set in 3 university-affiliated tertiary care emergency departments. We enrolled consecutive neurologically intact adults with nontraumatic headache undergoing lumbar puncture (LP) to rule out SAH. CSF was centrifuged, frozen and analyzed later in batch. SAH was defined by (1) subarachnoid blood on CT, (2) > 5 X 10(6) red blood cells/L in the final CSF tube and positive angiography, or (3) visible xanthochromia in CSF and positive angiography. All subjects lacking a normal CT and LP were telephoned at 30 days.Results-We enrolled 220 patients (mean age 42-16 years; CT rate 87.7%; angiography rate 5.9%). Two SAHs were identified: I with red blood cells without xanthochromia in the CSF and I with visibly xanthochromic CSF. The specificity of xanthochromia was 97% (95% CI: 92% to 99%) for visual inspection, but as low as 29% (95% CI: 23% to 35%) for 2 of the spectrophotometric definitions. Introducing spectrophotometry could lead to angiography in as many as 11% to 71% of patients undergoing LP.Conclusions-Spectrophotometric definitions of xanthochromia have only moderate to low specificity for SAH. Using spectrophotometry could increase angiography rates, thereby identifying more incidental aneurysms, increasing patient anxiety and exposing patients to unnecessary surgical or investigational complications without benefit.