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Objectives <p>This study identified the proportion of spontaneous subarachnoid haemorrhage (SAH) patients diagnosed by Lumbar Puncture (LP). Furthermore reporting the incidence of aneurysmal SAH if a CT scan performed within 6&#xa0;h was reported as negative, and finally investigated if there has been a change in practice since the new NICE guidance for the diagnosis of SAH was published in November 2022.</p> Methods <p>A pragmatic multicentre audit was conducted in the UK and Ireland capturing referrals to 25 Neurosurgical centres between 1st November 2020—31st October 2023. Case referral identification was done in each unit using local medical records and referral databases based on local protocols.</p> Results <p>10,187 cases of spontaneous SAH were diagnosed within the study period: 9,357 were diagnosed by CT and 717 by LP. 7% of all confirmed SAH cases underwent lumbar punctures to return a diagnosis of spontaneous SAH when a CT head scan was non-diagnostic. This yielded 213 (3%) diagnoses of aneurysmal SAH. 55 cases(1%) of aneurysmal SAH initially had negative CT head scans within 6&#xa0;h of ictus and a positive LP. We did not identify any evidence of a change in practice following the introduction of the NICE guidance in November 2022.</p> Conclusion <p>This study shows that LP continues to be an important diagnostic test that will confirm a diagnosis of aneurysmal SAH in a small, but significant number of patients with thunderclap headache. We provide new data that may impact the current NICE guidelines on the diagnosis of SAH.</p>

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Multicentre study of the role of lumbar puncture in the diagnosis of spontaneous subarachnoid haemorrhage

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  • 发表日期：

    2025年7月17日

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  • Daniel Thompson,
  • Sara Venturini,
  • Peter C. Whitfield,
  • Peter Hutchinson,
  • Nihal Gurusinghe,
  • Rikin Trivedi,
  • Adel Helmy,
  • Peter A Bodkin,
  • James LM Loan,
  • Alexandria Habiby,
  • Jack Latimer,
  • Ibrahim Ibrahim,
  • Bilal Benzahia,
  • Neil Simms,
  • Jamie Walsh,
  • Theresa McGarry,
  • Emer Moore,
  • Mario Teo,
  • Olivier Sluijters,
  • Shammael Selorfia,
  • Jahangir Sajjad,
  • Shuaib Khan,
  • Krunan Patel,
  • Hassan Othman,
  • Leevette Bay,
  • Kathy Reeve,
  • Muhammad Ammar Ali,
  • Ahmed Abd Elmohseen,
  • Mohsen Javadpour,
  • Laura Kehoe,
  • Deidre Nolan,
  • Paula Corr,
  • Deirdre Coffey,
  • Mohamed Okasha,
  • Victoria Collins,
  • Michael Helley,
  • Mark Highes,
  • John-Paul Haugh,
  • Molly Brewster,
  • Samih Hassan,
  • Allan Hall,
  • Mustafa El Sheikh,
  • Brian Ou Yong Ming,
  • Ajitha Kulasekaran,
  • Devansh Mitesh Shah,
  • Abbie Simpson,
  • Mihai Danciut,
  • Edward Goacher,
  • Asim Sheikh,
  • Fozia Saeed,
  • Elliot Tilling,
  • Michael D Kenkinson,
  • Ahmad M. S. Ali,
  • Tarek Elmoslemany,
  • Imran Farhad,
  • Saniya Ansari,
  • Nuzhat Choudhury,
  • Aaditya Gurjer,
  • Anjum Aarifa Khanom,
  • Arun Rupra,
  • Nigel Mendoza,
  • Puneet Sharma,
  • Ramesh Nair,
  • Yi Wang,
  • Gloria Quansah,
  • Lydia Parker,
  • Mohammad Al Hajjieh,
  • Ahilan Kailaya-Vasan,
  • James Knight,
  • Proma Dey,
  • Fatmah Noureldin,
  • Patrick Grover,
  • John Gerrard Hanrahan,
  • Hamza A Salhab,
  • Marwan Ali,
  • Jamail Bal,
  • Sobiya Bilal,
  • Simon Williams,
  • Steven Tominey,
  • Abdalla Mansour,
  • Fay Greenway,
  • Natalia Simon,
  • Gayathri Arul Selvan,
  • Anindya Bhowmik,
  • Eva Sherin Saravana Kumar,
  • Nitin Mukerji,
  • Nithish Jayakumar,
  • Ekene Nnamani,
  • Rasha Rajiv,
  • Laurence Glancz,
  • Natalia Rybka,
  • Ananyo Bagchi,
  • Andrew Edwards-Bailey,
  • Samir Matloob,
  • Jash Patel,
  • Abdalla Mansour,
  • Catherine Lamb,
  • Nethmini Rathnayake,
  • Dom Mahoney,
  • Boh Sofela,
  • Andrew Alade,
  • Abdurrahman Islim,
  • Jing Xian Lee,
  • Mohammed Ibrahim,
  • Swetha Joju,
  • Andy Bacon,
  • Matthew Sanders,
  • Jerry Philip,
  • Diederik Bulters,
  • Samuel Hall,
  • Emily Bligh,
  • Soham Bandyopadhyay,
  • Vishnu Suresh,
  • Howard Brydon,
  • Craig Robson,
  • Rosa Sun,
  • Anna Vassilou

摘要

Objectives

This study identified the proportion of spontaneous subarachnoid haemorrhage (SAH) patients diagnosed by Lumbar Puncture (LP). Furthermore reporting the incidence of aneurysmal SAH if a CT scan performed within 6 h was reported as negative, and finally investigated if there has been a change in practice since the new NICE guidance for the diagnosis of SAH was published in November 2022.

Methods

A pragmatic multicentre audit was conducted in the UK and Ireland capturing referrals to 25 Neurosurgical centres between 1st November 2020—31st October 2023. Case referral identification was done in each unit using local medical records and referral databases based on local protocols.

Results

10,187 cases of spontaneous SAH were diagnosed within the study period: 9,357 were diagnosed by CT and 717 by LP. 7% of all confirmed SAH cases underwent lumbar punctures to return a diagnosis of spontaneous SAH when a CT head scan was non-diagnostic. This yielded 213 (3%) diagnoses of aneurysmal SAH. 55 cases(1%) of aneurysmal SAH initially had negative CT head scans within 6 h of ictus and a positive LP. We did not identify any evidence of a change in practice following the introduction of the NICE guidance in November 2022.

Conclusion

This study shows that LP continues to be an important diagnostic test that will confirm a diagnosis of aneurysmal SAH in a small, but significant number of patients with thunderclap headache. We provide new data that may impact the current NICE guidelines on the diagnosis of SAH.