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  • Applying the Ottawa subarachnoid haemorrhage rule on a cohort of emergency department patients with headache

    Author(s)
    Chu, Kevin H
    Keijzers, Gerben
    Furyk, Jeremy S
    Eley, Robert M
    Kinnear, Frances B
    Thom, Ogilvie N
    Howell, Tegwen E
    Mahmoud, Ibrahim
    Ting, Joseph YS
    Brown, Anthony FT
    Griffith University Author(s)
    Keijzers, Gerben
    Thom, Ogilvie
    Year published
    2018
    Metadata
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    Abstract
    Objective: The Ottawa subarachnoid haemorrhage (SAH) rule suggests that alert patients older than 15 years with a severe nontraumatic headache reaching maximum intensity within 1 h and absence of high-risk variables effectively have a SAH ruled out. We aimed to determine the proportion of emergency department (ED) patients with any headache fulfilling the entry criteria for the Ottawa SAH rule. Patients and methods: The Ottawa SAH rule was applied retrospectively in a substudy of a prospective snapshot of 34 EDs in Queensland, Australia, carried out over 4 weeks in September 2014. Patients older than 18 years or more with ...
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    Objective: The Ottawa subarachnoid haemorrhage (SAH) rule suggests that alert patients older than 15 years with a severe nontraumatic headache reaching maximum intensity within 1 h and absence of high-risk variables effectively have a SAH ruled out. We aimed to determine the proportion of emergency department (ED) patients with any headache fulfilling the entry criteria for the Ottawa SAH rule. Patients and methods: The Ottawa SAH rule was applied retrospectively in a substudy of a prospective snapshot of 34 EDs in Queensland, Australia, carried out over 4 weeks in September 2014. Patients older than 18 years or more with a nontraumatic headache of any potential cause were included. Clinical data and results of investigations were collected. Results: Data were available for 644 (76%) patients. A total of 149 (23.1%, 95% confidence interval: 20.0–26.5%) fulfilled and 495 (76.9%, 95% confidence interval: 73.5–80.0%) did not fulfil the entry criteria. In patients who fulfilled the entry criteria, 30 (<5% overall) did not have any high-risk variables for SAH. In patients who fulfilled the entry criteria and had at least 1 high-risk feature, almost half (46%) received a computed tomographic brain. No SAH were missed. Conclusion: In this descriptive observational study, the majority of ED patients presenting with a headache did not fulfil the entry criteria for the Ottawa SAH rule. Less than 5% of the patients in this cohort could have SAH excluded on the basis of the rule. More definitive studies are needed to determine an accepted benchmark for the proportion of patients receiving further work-up (computed tomographic brain) after fulfilling the entry criteria for the Ottawa SAH rule.
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    Journal Title
    European Journal of Emergency Medicine
    DOI
    https://doi.org/10.1097/MEJ.0000000000000523
    Note
    This publication has been entered into Griffith Research Online as an Advanced Online Version.
    Subject
    Clinical sciences
    Clinical sciences not elsewhere classified
    Publication URI
    http://hdl.handle.net/10072/376374
    Collection
    • Journal articles

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