Defending a traditional practice in the modern era: The use of lumbar puncture in the investigation of subarachnoid haemorrhage
| Autor: | Sean Martin, Sachin S Mandalia, Edward J St George, Calum McGregor, Ian M Godber, Adam Young, Mario Teo |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Severe headache medicine.medical_specialty Adolescent Cost-Benefit Analysis Neuroimaging Computed tomography Spinal Puncture Neurosurgical Procedures Young Adult Aneurysm Xanthochromia medicine Humans Child Aged Aged 80 and over medicine.diagnostic_test business.industry Lumbar puncture Infant Reproducibility of Results Bilirubin General Medicine Middle Aged Subarachnoid Hemorrhage medicine.disease Child Preschool Oxyhemoglobins Female Surgery Subarachnoid haemorrhage Neurology (clinical) Radiology Tomography X-Ray Computed business Cerebral angiography |
| Zdroj: | British Journal of Neurosurgery. 29:799-803 |
| ISSN: | 1360-046X 0268-8697 |
| DOI: | 10.3109/02688697.2015.1084998 |
| Popis: | Acute severe headache is a common medical presentation, and a common area of diagnostic uncertainty. Subarachnoid haemorrhage (SAH) is the cause in a minority of patients and has a high rate of morbidity and mortality. Therefore, its conclusive diagnosis with computed tomography (CT) or lumbar puncture (LP) is paramount. With advancement in imaging technology, emerging evidence now suggests that LP is no longer required for a subset of patients as CT has 100% sensitivity in detecting SAH, when performed under specific conditions.To assess the proportion of patients with conclusive CSF xanthochromia results following a negative CT scan in suspected SAH to determine the diagnostic efficacy of LP.CSF bilirubin and oxyhaemoglobin spectrophotometric absorbance data from all centres in a regional health board were identified for consecutive patients over a 6-month period. Results were stratified as conclusive (positive or negative), or inconclusive according to national guidelines.239 of 255 (93.7%) results were conclusive: 89.0% were negative (227 of 255). 4.7% of results were positive (12 of 255), revealing 4 cerebral aneurysms requiring treatment. 16 out of 255 (6.3%) samples were inconclusive, yielding 1 aneurysm requiring treatment. In the same period, there were 27 CT-positive cases of SAH.LP has a high diagnostic yield, eliminating the need for neurosurgical opinion or investigation in almost 90% of cases. The test is both cost and time efficient and subjects only a small number of patients to the radiation and contrast risks of angiography. |
| Databáze: | OpenAIRE |
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