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 Urgent CT Head and subsequent Lumbar Puncture for suspected Subarachnoid Haemorrhage in a London District General Hospital
Poster Title: Urgent CT Head and subsequent Lumbar Puncture for suspected Subarachnoid Haemorrhage in a London District General Hospital
Submitted on 02 Nov 2020
Author(s): Nicholas Gikas, Miguel Ribeiro DaCosta, Tat Tee Koh
Affiliations: West Middlesex University Hospital
This poster was presented at BIR Annual Congress 2020
Poster Views: 84
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Poster Information
Abstract: Background:
SAH is a life threatening neurosurgical emergency which commonly effects younger patients than other types of stroke. It results from bleeding of aneurysms and arterio-ventricular malformations within the neurovasculature. All patients with suspected SAH should undergo a CT head, and a negative test should be confirmed with a lumbar puncture at least 12 hours after the onset of headache.

We retrospectively identified 125 patients over a 2 month period who underwent CT Head to rule out an atraumatic bleed, by looking at keywords in the CT requests. We searched through clerking information to match clerking history to CT request, referrals made, whether LP was performed and when, whether patients discharged were seen by a senior prior to discharge. All information was collected on a secure Microsoft Excel spreadsheet. All information was independently scrutinised by two doctors and one radiology consultant.

Of 125 scans, 1 (0.8%) was positive for SAH, 11 were abnormal with non SAH pathology, and 113 normal. From clerking documentation, we found that only 67 (53%) of scans were appropriately performed to rule out SAH. Of 47 patients appropriately admitted into hospital with suspected SAH, 21 received a Lumbar puncture, and all were performed at least 12 hours from headache onset (where possible to calculate).

SAH should be considered in any patient presenting with sudden onset severe headache with or without focal neurology or new seizure activity. A negative CT does not rule out SAH and patients must undergo an LP after 12 hours.
Summary: Service Evaluation of SAH protocol from emergency CT Head in A&E to lumbar puncture to rule out SAH after negative CT.References: Report abuse »
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