775 Assessment of headache in the emergency department to rule out subarachnoid haemorrhage: a systematic review of diagnostic accuracy
Notice bibliographique
Résumé
Aims/Objectives/Background Acute headache accounts for around 2% of Emergency Department attendances. Headache guidelines recommend non-contrast head computed tomography (CT) followed by lumbar puncture to exclude subarachnoid haemorrhage (SAH). Advances in imaging technology have led emergency physicians to question the necessity of routine lumbar puncture after negative CT. This systematic review assessed diagnostic strategies for neurologically intact headache patients. Methods/Design In February 2020, 18 electronic databases (including MEDLINE and Embase) were searched for studies of any clinical decision rule or diagnostic test for assessing neurologically intact severe headache patients, reaching maximum intensity within an hour. Studies were quality assessed using the QUADAS-2 tool. Diagnostic accuracy data were extracted into 2x2 tables to calculate sensitivity, specificity, false-positive and false-negative rates. Where appropriate, hierarchical bivariate meta-analysis was used to synthesise results. Results/Conclusions Thirty-seven studies were included. Eight studies assessing the accuracy of the Ottawa SAH clinical decision rule were pooled; sensitivity was 99.5%, specificity was 23.7%. Four studies (with neuroradiology expertise) assessing CT within six hours of headache onset were pooled; sensitivity was 98.7%, specificity was 100%. CT sensitivity beyond six hours was considerably lower (≤90%; 2 studies). Three studies assessing lumbar puncture (spectrophotometric analysis) following negative CT were pooled; sensitivity was 100%, specificity was 95.2%. LP-related adverse events were reported in 5.3–9.5% patients (2 studies). The evidence suggests that the Ottawa Rule has limited value for ruling out SAH; the high false positive rate means that its use would potentially result in 76% SAH-negative patients undergoing further investigation with no additional benefit. Modern CT within six hours of headache onset (with images assessed by a neuroradiologist) is highly accurate and likely to be sufficient to rule out SAH. However, sensitivity reduces considerably over time. The CT-LP pathway remains a highly sensitive pathway for detecting SAH, although LP resulted in some false-positives and adverse events.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,036 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».