Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study.
Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study.
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DOI：
10.1136/bmj.d4277
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发表时间：
2011-07-18
期刊：
影响因子：
--
通讯作者：
Wells GA
中科院分区：
文献类型：
--
作者：
Perry JJ;Stiell IG;Sivilotti ML;Bullard MJ;Emond M;Symington C;Sutherland J;Worster A;Hohl C;Lee JS;Eisenhauer MA;Mortensen M;Mackey D;Pauls M;Lesiuk H;Wells GA
目的测量现代第三代计算机断层扫描在评估可能的蛛网膜下腔出血的急诊患者中的敏感性，特别是在头痛发作后六小时内进行的敏感性。设计前瞻性队列研究。2000年至2009年，在加拿大设立了11个三级护理急诊科。参与者神经系统完整的成年人与一个新的急性头痛的强度在一个小时内达到峰值，在其中的计算机断层扫描是由治疗医生下令排除蛛网膜下腔出血。主要结果测量蛛网膜下腔出血定义为计算机断层扫描显示的任何蛛网膜下腔血液，脑脊液中的黄色素，或脑血管造影阳性结果收集的最后一管脑脊液中的任何红细胞。结果在3132例患者中（平均年龄45.1岁，2571例（82.1%）有史以来最严重的头痛），240例（7.7%）有蛛网膜下腔出血。CT对蛛网膜下腔出血的敏感性为92.9%（95%置信区间为89.0%~ 95.5%），特异性为100%（99.9%~ 100%），阴性预测值为99.4%（99.1%~ 99.6%），阳性预测值为100%（98.3%~ 100%）。在头痛发作6小时内扫描的953名患者中，所有121名蛛网膜下腔出血患者均通过计算机断层扫描识别，灵敏度为100%（97.0%至100.0%），特异性为100%（99.5%至100%），阴性预测值为100%（99.5%至100%），阳性预测值为100%（96.9%至100%）。结论现代第三代计算机断层扫描在头痛发作后六小时内进行并由合格的放射科医生进行解释时，在识别蛛网膜下腔出血方面极其敏感。
Objective To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset. Design Prospective cohort study. Setting 11 tertiary care emergency departments across Canada, 2000-9. Participants Neurologically intact adults with a new acute headache peaking in intensity within one hour of onset in whom a computed tomography was ordered by the treating physician to rule out subarachnoid haemorrhage. Main outcome measures Subarachnoid haemorrhage was defined by any of subarachnoid blood on computed tomography, xanthochromia in cerebrospinal fluid, or any red blood cells in final tube of cerebrospinal fluid collected with positive results on cerebral angiography. Results Of the 3132 patients enrolled (mean age 45.1, 2571 (82.1%) with worst headache ever), 240 had subarachnoid haemorrhage (7.7%). The sensitivity of computed tomography overall for subarachnoid haemorrhage was 92.9% (95% confidence interval 89.0% to 95.5%), the specificity was 100% (99.9% to 100%), the negative predictive value was 99.4% (99.1% to 99.6%), and the positive predictive value was 100% (98.3% to 100%). For the 953 patients scanned within six hours of headache onset, all 121 patients with subarachnoid haemorrhage were identified by computed tomography, yielding a sensitivity of 100% (97.0% to 100.0%), specificity of 100% (99.5% to 100%), negative predictive value of 100% (99.5% to 100%), and positive predictive value of 100% (96.9% to 100%). Conclusion 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.
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