HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schofield, M L A Articles by Griffiths, P D Search for Related Content PubMed PubMed Citation Articles by Schofield, M L A Articles by Griffiths, P D

How well do we investigate patients with suspected subarachnoid haemorrhage? The continuing need for cerebrospinal fluid investigations

¹ Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK
² Barnsley District Hospital, Barnsley, UK
³ Academic Unit of Radiology, University of Sheffield, Sheffield, UK

Correspondence to:
Correspondence to:
Professor Paul D Griffiths
Academic Unit of Radiology, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; P.Griffiths{at}Sheffield.ac.uk

Objective: To demonstrate the extent of compliance with established guidelines for the investigation of suspected subarachnoid haemorrhage (SAH) and the implications of non-compliance.

Design: Prospective observational study of practice in three hospitals in the Trent region.

Setting: One teaching hospital with a tertiary neuroscience referral centre and two large district general hospitals.

Participants: 50 consecutive patients from each centre referred for suspected SAH with negative computed tomography.

Main outcome measures: Diagnosis of SAH confirmed or excluded according to guidelines.

Results: When the data from the three centres were combined (n = 150 computed tomography negative cases) cerebrospinal fluid (CSF) investigation was not performed in 60/150 (40%). In the 90 cases where CSF studies were performed SAH was confirmed in 11 (12%).

Conclusion: There is significant non-compliance in following the established guidelines for the investigation of SAH at the centres studied. As the primary cause of non-traumatic SAH is ruptured aneurysm, which is associated with high morbidity and mortality from second haemorrhage, this highlights a major source of concern for clinical governance.

Keywords: subarachnoid haemorrhage; cerebrospinal fluid; lumbar puncture; cranial computed tomography

Abbreviations: CSF, cerebrospinal fluid; SAH, subarachnoid haemorrhage

This article has been cited by other articles:

				D.P. Breen, C.W. Duncan, A.E. Pope, A.J. Gray, and R. Al-Shahi Salman Emergency department evaluation of sudden, severe headache QJM, June 1, 2008; 101(6): 435 - 443. [Abstract] [Full Text] [PDF]