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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Emerg+Med
2015 ; 33
(11
): 1597-601
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Risk-benefit analysis of lumbar puncture to evaluate for nontraumatic
subarachnoid hemorrhage in adult ED patients
#MMPMID26189054
Migdal VL
; Wu WK
; Long D
; McNaughton CD
; Ward MJ
; Self WH
Am J Emerg Med
2015[Nov]; 33
(11
): 1597-601
PMID26189054
show ga
OBJECTIVE: The objective of the study is to compare the risks and benefits of
lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal
head computed tomographic (CT) scan. METHODS: This was an observational study of
adult emergency department patients at a single hospital who presented with
headache and underwent LP after a normal head CT to evaluate for SAH. Lumbar
puncture results classified as indicating a SAH included xanthochromia in
cerebrospinal fluid (CSF) or red blood cells in the final tube of CSF with an
aneurysm or arteriovenous malformation on cerebral angiography. An LP-related
complication was defined as hospitalization or a return visit due to symptoms
attributed to the LP. Proportions of the study patients who had SAH diagnosed by
LP and who experienced an LP-related complication were compared. RESULTS: The
study included 302 patients, including 2 (0.66%) who were diagnosed with SAH
based on LP (number needed to diagnose, 151); both of these patients had a known
intracranial aneurysm. Eighteen (5.96%) patients experienced an LP-related
complication (P < .01 compared with number with SAH diagnosed; number needed to
harm, 17). Complications included 12 patients with low-pressure headaches, 4 with
pain at the LP site, and 2 with contaminated CSF cultures. CONCLUSION: The yield
of LP for diagnosing SAH in adults with nontraumatic headache after a normal head
CT was very low. The severity of LP-related complications was low, but
complications were more common than SAH diagnoses. Lumbar puncture may not be
advisable after a normal head CT to evaluate for SAH, particularly in patients
with low-risk clinical features for SAH.
|*Emergency Service, Hospital
[MESH]
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Female
[MESH]
|Headache/*etiology
[MESH]
|Hospitalization/statistics & numerical data
[MESH]
free
free
free
