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KMID : 0385920140250060703
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Journal of the Korean Society of Emergency Medicine
2014 Volume.25 No. 6 p.703 ~ p.714
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Clinical Predictors of Subarachnoid Hemorrhage in Patients with Acute Non-traumatic Headache in Emergency Department
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Jeong Seung-Min
Kim Yu-Jin
Kim Kyu-Seok
Shin Sang-Do
Kim Joong-Hee
Jeong Jin-Hee
Kang Chang-Woo
Lee Soo-Hoon
Park Chan-Jong
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Abstract
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Purpose: Missing subarachnoid hemorrhage (SAH) cancause catastrophic results. We aimed to find clinical factorsfor predicting SAH in neurologically intact patients withacute non-traumatic headache visiting the emergencydepartment (ED).
Methods: This was a retrospective chart review study. Datawere collected from September 2006 until October 2011. We included patients aged over 16 with acute non-traumaticheadache who had brain imaging work up results duringED visits. Information on candidate clinical predictor variableswas obtained from previous reports, and the outcomewas confirmed SAH in brain imaging work up or cerebrospinalfluid study. We found the predictors for SAHthrough multivariable analysis with variables chosen in univariableanalysis considering clinical application. Then wesimulated possible SAH prediction scoring models usingreceiver operating characteristic (ROC) analysis andassessed model fit through the Hosmer-Lemeshow test.
Results: A total of 3294 patients were enrolled. Seven clinicalcharacteristics were proven for relation of SAH; age, visitingemergency department within six hours from symptomonset time, visiting mode, vomiting, neck pain or neck stiffness,blood pressure, and respiratory rate. We constructedsix available SAH prediction scoring models. The areaunder the ROC curves of each model ranged from 0.810 to0.834 and all simulated models were good-fit. With thesemodels, we can expect to reduce unnecessary computedtomography use.
Conclusion: Seven clinical predictors could be helpful inselection of high risk patients of SAH. The proposed SAHprediction models using these characteristics will have to betested prospectively for external validation.
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KEYWORD
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Subarachnoid hemorrhage, Headache, Clinical prediction rule
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