Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage
Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage
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DOI：
10.1016/j.annemergmed.2007.10.007
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发表时间：
2008-06-01
影响因子：
6.2
通讯作者：
Baraff, Larry J.
中科院分区：
文献类型：
--
作者：
Byyny, Richard L.;Mower, William R.;Baraff, Larry J.
研究目的：急诊医生对头痛患者使用无对比的头颅计算机断层扫描（CT）成像来识别动脉瘤或动静脉畸形引起的蛛网膜下腔出血。鉴于足够高的灵敏度，CT成像可用作这些患者的明确诊断研究。本研究的目的是确定所有自发性蛛网膜下腔出血和动脉瘤或动静脉畸形引起的非增强头颅CT的敏感性。方法：这是一项回顾性研究，在城市三级学术急诊科（艾德）。我们结合使用非对比头颅CT放射学编码、腰穿结果、国际疾病分类、第九版出院诊断和病历审查，确定了2001年8月1日至2004年12月31日期间所有因自发性蛛网膜下腔出血而前往三级护理学术艾德就诊的患者。我们确定患者是否通过头颅CT或腰椎穿刺诊断，是否存在头痛和意识水平在艾德presentation.Results的存在，以及他们是否有动脉瘤或动静脉畸形：我们确定了149例患者被诊断为自发性蛛网膜下腔出血在研究期间。头颅CT平扫诊断139例，其中10例经腰椎穿刺确诊。这产生了93%的总体CT扫描灵敏度（95%置信区间[CI] 88%至97%）。在149例蛛网膜下腔出血中，117例（79%）有动脉瘤或动静脉畸形;头颅CT扫描显示117例中有110例蛛网膜下腔出血，敏感性为94%（95%CI 88%至98%）。对67例有蛛网膜下腔出血和血管病变的头痛和精神状态正常的患者（无论是动脉瘤还是动静脉畸形），头颅CT扫描的灵敏度为91%（95% CI 82%至97%）。非增强CT成像在检测动脉瘤或动静脉瘤引起的自发性蛛网膜下腔出血方面的敏感性不足，畸形
Study objective: Emergency physicians use noncontrast cranial computed tomographic (CT) imaging of headache patients to identify subarachnoid hemorrhage caused by aneurysms or arteriovenous malformations. Given sufficiently high sensitivity, CT imaging could be used as a definitive diagnostic study in these patients. The purpose of this study is to determine the sensitivity of noncontrast cranial CT in detecting all spontaneous subarachnoid hemorrhages and those caused by aneurysm or arteriovenous malformation.Methods: This was a retrospective review performed at an urban tertiary academic emergency department (ED). Using a combination of noncontrast cranial CT radiology coding, lumbar puncture results, International Classification of Diseases, Ninth Revision discharge diagnosis, and medical record review, we identified all patients who presented to a tertiary care academic ED from August 1, 2001, to December 31, 2004, with spontaneous subarachnoid hemorrhage. We determined whether patients were diagnosed by cranial CT or lumbar puncture, the presence of headache and level of consciousness at ED presentation, and whether or not they had an aneurysm or arteriovenous malformation.Results: We identified 149 patients who were diagnosed with spontaneous subarachnoid hemorrhage during the study period. Noncontrast cranial CT scan diagnosed 139 patients, and 10 were diagnosed with lumbar puncture. This yielded an overall CT scan sensitivity of 93% (95% confidence interval [CI] 88% to 97%). Of the 149 with subarachnoid hemorrhage, 117 (79%) had aneurysm or arteriovenous malformation; cranial CT scan demonstrated subarachnoid hemorrhage in 110 of the 117, for a sensitivity of 94% (95% CI 88% to 98%). For the 67 patients presenting with headache and normal mental status who had a subarachnoid hemorrhage and vascular lesions (either aneurysm or arteriovenous malformation), the sensitivity of cranial CT scan was 91% (95% CI 82% to 97%).Conclusion: Noncontrast CT imaging exhibits inadequate sensitivity to serve as a sole diagnostic modality in detecting spontaneous subarachnoid hemorrhage caused by aneurysm or arteriovenous malformation.