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  • Title: Diagnosis of subarachnoid haemorrhage following a negative computed tomography for acute headache: a Bayesian analysis.
    Author: Coats TJ, Loffhagen R.
    Journal: Eur J Emerg Med; 2006 Apr; 13(2):80-3. PubMed ID: 16525234.
    Abstract:
    OBJECTIVES: As access to computed tomography scanning has become easier, patients with a lower probability of serious pathology are being scanned. We asked how many lumbar punctures need to be performed to detect each subarachnoid haemorrhage in these lower-risk patients. METHODS: Literature review and Bayesian analysis of the application of the data to clinical practice. RESULTS: A computed tomography scan for acute headache has a negative likelihood ratio of 0.02 if the computed tomography is performed at <12 h, 0.07 at <24 h and 0.18 at >24 h. A low pre-test probability, for example 1 in 20 (5%), and a negative computed tomography at <12 h means that more than 1000 lumbar punctures would be required to detect each subarachnoid haemorrhage. CONCLUSIONS: In patients who have a low pre-computed tomography probability of subarachnoid haemorrhage and undergo an early computed tomography scan, the risk/benefit ratio of lumbar puncture is unclear. A decision rule (risk stratification system) might improve our ability to help the patient make an informed choice.
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