Rapid recognition tools for subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) carries a substantial burden of morbidity and mortality—therefore, the development of methods to rapidly detect SAH with high sensitivity is very important. Paramedics are frequently called to patients complaining of headache and the treatment for patients with clinically likely SAH is mostly straightforward for prehospital clinicians. However, a number of patients present with atypical symptoms and 12% of all SAHs are overlooked on initial assessment (Kowalski et al, 2004).

The study being discussed in this article aimed to develop a new clinical decision rule using only objectively measurable predictors to exclude SAH. The authors aimed to offer higher specificity than the previously developed Ottawa SAH rule, an evidence-based, two-stage clinical decision rule, while maintaining Ottawa's 100% sensitivity.

A total of 1899 patients aged over 15 years old with a main complaint of headache and presenting within 14 days were considered for enrolment from five general hospitals in Japan between April 2011 and March 2014. Patients were aged 16–98 years of age with a mean age of 53.