Diagnostic Accuracy and Application of Subarachnoid Hemorrhage Decision Rules Among Patients With Non-Traumatic Acute Headache: A Systematic Review and Meta-Analysis.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-07-02 DOI:10.1111/acem.70087

Mahdi Roostaei, Nadia Saniee, Seyyed Amir Yasin Ahmadi, Mahdi Rezai, Arash Tehrani-Banihashemi, Hamid Reza Baradaran, Farzaneh Barzkar

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引用次数: 0

Abstract

Background: The Ottawa and Emerald rules were developed to aid in the diagnosis of subarachnoid hemorrhage (SAH) and to determine whether a CT scan is necessary for patients presenting with non-traumatic acute headaches in the emergency department. Numerous studies have been conducted to validate these clinical decision rules. In this study, we aimed to investigate the pooled diagnostic accuracy of these rules and their impact on imaging utilization.

Methods: In this PRISMA-DTA-compliant systematic review, a comprehensive search was done in databases including PubMed, Scopus, Embase, and Web of Science. Then, screening, selection of studies, and data extraction were performed and the QUADAS-2 tool was used for critical appraisal. The true positives (TP), false negatives (FN), false positives (FP), and true negatives (TN) were extracted to calculate pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and Diagnostic Odds Ratio (DOR) with 95% CIs. The effect of Ottawa rule on CT scan utilization was assessed by calculating pooled odds ratios for the number of CT scans in SAH and non-SAH groups before and after applying the rule.

Results: The pooled sensitivity, specificity, negative LR, and positive LR for the Ottawa SAH rule were 99% (95% CI: 92%-100%), 23% (95% CI: 16%-32%), 0.025 (95% CI: 0.003%-0.193%), and 1.29 (95% CI: 1.16%-1.42%) respectively. Similarly, these measures for the Emerald SAH rule were 99% (95% CI: 71%-100%), 27% (95% CI: 15%-43%), 0.065 (95% CI: 0.004%-1.072%), and 1.34 (95% CI: 1.1%-1.62%), respectively. The pooled odds ratio for CT scan utilization for the Ottawa rule was 1.15 (95% CI: 0.62%-2.13%).

Conclusion: Both rules are highly sensitive for excluding SAH in patients with non-traumatic acute headaches presenting to the emergency department but have low specificity and do not significantly reduce CT scan utilization.

Trial registration: PROSPERO registration number: CRD42023476444.

查看原文本刊更多论文

非外伤性急性头痛患者蛛网膜下腔出血判定规则的诊断准确性和应用：一项系统综述和荟萃分析。

背景：渥太华和翡翠规则的制定是为了帮助诊断蛛网膜下腔出血（SAH），并确定在急诊科出现非创伤性急性头痛的患者是否需要CT扫描。已经进行了大量的研究来验证这些临床决策规则。在本研究中，我们旨在探讨这些规则的综合诊断准确性及其对影像学利用的影响。方法：在这篇符合prisma - dta的系统综述中，在PubMed、Scopus、Embase和Web of Science等数据库中进行了全面的检索。然后，进行筛选、研究选择和数据提取，并使用QUADAS-2工具进行关键评估。提取真阳性（TP）、假阴性（FN）、假阳性（FP）和真阴性（TN），计算95% ci的合并敏感性、特异性、阳性似然比（LR）、阴性LR和诊断优势比（DOR）。通过计算应用渥太华规则前后SAH组和非SAH组CT扫描次数的合并优势比，评估渥太华规则对CT扫描利用率的影响。结果：渥太华SAH规则的总敏感性、特异性、阴性LR和阳性LR分别为99% （95% CI: 92%-100%）、23% （95% CI: 16%-32%）、0.025 （95% CI: 0.003%-0.193%）和1.29 （95% CI: 1.16%-1.42%）。同样，Emerald SAH规则的这些测量值分别为99% （95% CI: 71%-100%）、27% （95% CI: 15%-43%）、0.065 （95% CI: 0.004%-1.072%）和1.34 （95% CI: 1.1%-1.62%）。渥太华规则CT扫描利用率的合并优势比为1.15 （95% CI: 0.62%-2.13%）。结论：这两项规则对于排除急诊非外伤性急性头痛患者的SAH具有高度敏感性，但特异性较低，并没有显著降低CT扫描的使用率。试验注册：普洛斯彼罗注册号：CRD42023476444。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.