头部CT是否扫描:疑似蛛网膜下腔出血的临床困境渥太华蛛网膜下腔出血规则的有效性研究。

Advanced Journal of Emergency Medicine Pub Date : 2018-04-01 eCollection Date: 2018-01-01 DOI:10.22114/AJEM.v0i0.73
Abdul-Sajjad Pathan, Eleonora Chakarova, Aamir Tarique
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引用次数: 3

摘要

简介:渥太华蛛网膜下腔出血规则(OSR)是一种临床决策工具,用于排除15岁以上急诊科(ED)急性发作的非创伤性头痛患者蛛网膜下腔出血(SAH)。目的:本研究的主要目的是在英国单一国家卫生服务(NHS)环境中对OSR进行外部验证,其次,在不使用决策规则的情况下将其与我们目前的实践进行比较。方法:回顾性分析2016年1月至12月登记的所有头痛患者的计算机病历。数据被手工绘制在个人病历的数据表上。符合OSR预设的纳入和排除标准的患者被纳入分析。根据OSR,如果患者符合6项标准中的任何一项(年龄> 40岁,颈部僵硬/疼痛,意识丧失,运动时发病,雷击头痛,检查时颈部屈曲受限),则需要进一步诊断。所有患者都在电脑系统上随访了6个月,如果患者再次出现在急诊科或已经死亡,它会被突出显示。结果:共有737例急诊科就诊的急性头痛患者进行了潜在的资格审查。其中,估计有649人符合条件。在排除不符合预定纳入标准的485例患者和按排除标准排除的19例患者后,145例(19.7%)患者纳入分析。有5例SAH,发生率为3.4% (95% CI 1.3% - 8.3%)。SAH的敏感性为100% (95% CI, 46.3% - 100%);特异性为44.2% (95% CI, 36% - 53%);阳性预测值为6.02% (95% CI 2.2% - 14.1%);阴性预测值为100% (95% CI, 92.7% - 100%)。结论:虽然特异性较差,但OSR是一种高度敏感、简单的工具,可用于排除急诊科头痛患者的SAH。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

To Head CT Scan or Not: The Clinical Quandary in Suspected Subarachnoid Hemorrhage; a Validation Study on Ottawa Subarachnoid Hemorrhage Rule.

To Head CT Scan or Not: The Clinical Quandary in Suspected Subarachnoid Hemorrhage; a Validation Study on Ottawa Subarachnoid Hemorrhage Rule.

To Head CT Scan or Not: The Clinical Quandary in Suspected Subarachnoid Hemorrhage; a Validation Study on Ottawa Subarachnoid Hemorrhage Rule.

Introduction: The Ottawa Subarachnoid Hemorrhage rule (OSR) is a clinical decision tool identified for ruling out subarachnoid hemorrhage (SAH) in those patient above 15 years of age who present to the emergency department (ED) with acute onset atraumatic headache.

Objective: The primary objective of this study was to externally validate the OSR in a single national health service (NHS) setting in the UK and secondly, to compare it with our current practice without using a decision rule.

Method: A retrospective review of computerized medical records was done for all patients registered with headaches from January to December 2016. The data were manually charted on a data sheet from individual patient records. Patients fulfilling the preset inclusion and exclusion criteria as per the OSR were enrolled in the analysis. According to the OSR, if patient had any of the 6 criteria enlisted (age > 40 years, neck stiffness/pain, witnessed loss of consciousness, onset during exertion, thunderclap headache, limited neck flexion on examination), further diagnostic decision was required. All patients were followed up for 6 months on the computer system as it gets highlighted if the patient is represented again to the ED or is deceased.

Results: A total of 737 ED visits with acute headache were reviewed for potential eligibility. Out of these, 649 were estimated to be eligible. On excluding 485 patients that could not meet the predetermined inclusion criteria and 19 patients as per the exclusion criteria, 145 (19.7%) patients were included in the analysis. There were 5 cases of SAH, yielding an incidence of 3.4 % (95% CI 1.3 % - 8.3 %). The sensitivity for SAH was 100% (95% CI, 46.3 % - 100 %); specificity of 44.2 % (95% CI, 36 % - 53 %); positive predictive value of 6.02 % (95% CI 2.2 % - 14.1 %); and negative predictive value of 100% (95% CI, 92.7 % - 100%).

Conclusion: Although being poorly specific, the OSR is a highly sensitive, simple tool for ruling out SAH in alert patients with a headache in ED settings.

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