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10.1016/j.ajem.2015.06.048

http://scihub22266oqcxt.onion/10.1016/j.ajem.2015.06.048
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C4628593!4628593!26189054
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suck abstract from ncbi


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pmid26189054      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 PMID26189054show ga
  • Objective: To compare the risks and benefits of lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal head computed tomography (CT) scan. Methods: This was an observational study of adult emergency department (ED) patients at a single hospital who presented with headache and underwent LP after a normal head CT to evaluate for SAH. LP 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 a LP-related complication (p<0.01 compared to 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. LP may not be advisable after a normal head CT to evaluate for SAH, particularly in patients with low-risk clinical features for SAH.
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