EBQ:Perry Subarachnoid Haemorrhage Study - Revision history

Danbot: Added Study Design section

2026-03-21T22:42:49Z

Added Study Design section

← Older revision		Revision as of 22:42, 21 March 2026
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	*60% women		*60% women

	===Inclusion Criteria===		===Study Design==
			*Prospective, multicenter cohort study
			*12 Canadian academic emergency departments
			*N = 2,131 alert patients presenting with acute headache
			*Study period: November 2000 - December 2009
			*Primary Outcome: subarachnoid hemorrhage on CT, lumbar puncture, or angiography within 30 days

			==Inclusion Criteria===
	*>15 years old		*>15 years old
	*Acute headache reaching peak intensity within one hour		*Acute headache reaching peak intensity within one hour

Ostermayer: /* Criticisms */

2016-02-15T01:54:07Z

Criticisms

← Older revision		Revision as of 01:54, 15 February 2016
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	* Higher incidence of "worst headache ever"		* Higher incidence of "worst headache ever"

	==Criticisms==		==Criticisms and Further Discussion==
	Not all study subjects underwent a gold standard lumbar puncture, possibly resulting in an underestimation of the rate of false-negative CT. However, investigators endeavored to follow up all subjects at 6 months using medical records and phone calls; no patients contacted received a subsequent diagnosis of SAH. Only 50 patients could not be followed up by these methods. For these 50, review of referrals to neurosurgical centers and coroner reports failed to suggest that any had had a missed SAH. The sensitivity and specificity should then be viewed as for "clinically significant SAH" as non-clinically significant SAH could have been missed.		*Not all study subjects underwent a gold standard lumbar puncture, possibly resulting in an underestimation of the rate of false-negative CT. However, investigators endeavored to follow up all subjects at 6 months using medical records and phone calls; no patients contacted received a subsequent diagnosis of SAH. Only 50 patients could not be followed up by these methods. For these 50, review of referrals to neurosurgical centers and coroner reports failed to suggest that any had had a missed SAH. The sensitivity and specificity should then be viewed as for "clinically significant SAH" as non-clinically significant SAH could have been missed.
			*Meta-analysis, heavily weighted from this paper provides a negative head CT in a neurologically normal patient, performed within 6 hours of onset provides a miss rate of SAH of 2/1000 patients.<ref>Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Stroke 2016. PMID: 26797666</ref>

	==Funding==		==Funding==

Ostermayer at 23:52, 5 February 2015

2015-02-05T23:52:31Z

← Older revision		Revision as of 23:52, 5 February 2015
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	\| fulltexturl= http://www.bmj.com/content/341/bmj.c5204?view=long&pmid=21030443		\| fulltexturl= http://www.bmj.com/content/341/bmj.c5204?view=long&pmid=21030443
	\| pdfurl= http://www.bmj.com/content/341/bmj.c5204.pdf		\| pdfurl= http://www.bmj.com/content/341/bmj.c5204.pdf
			\| status=Under Review
	}}		}}

Neil.m.young: funding added

2015-02-05T15:48:30Z

funding added

← Older revision		Revision as of 15:48, 5 February 2015
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	==Funding==		==Funding==
			*Canadian Institutes for Health Research (grants 67107, 153742)
			*The Ontario Ministry of Health and Long Term Care
			*The Physicians of Ontario through the Physician’s Services Incorporated Foundation (01-39)

	==Sources==		==Sources==

Neil.m.young: addition to criticisms

2015-02-05T15:46:29Z

addition to criticisms

← Older revision		Revision as of 15:46, 5 February 2015
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	==Criticisms==		==Criticisms==
	Not all study subjects underwent lumbar puncture, possibly resulting in an underestimation of the rate of false-negative CT. However, investigators endeavored to follow up all subjects at 6 months using medical records and phone calls; no patients contacted received a subsequent diagnosis of SAH. Only 50 patients could not be followed up by these methods. For these 50, review of referrals to neurosurgical centers and coroner reports failed to suggest that any had had a missed SAH.		Not all study subjects underwent a gold standard lumbar puncture, possibly resulting in an underestimation of the rate of false-negative CT. However, investigators endeavored to follow up all subjects at 6 months using medical records and phone calls; no patients contacted received a subsequent diagnosis of SAH. Only 50 patients could not be followed up by these methods. For these 50, review of referrals to neurosurgical centers and coroner reports failed to suggest that any had had a missed SAH. The sensitivity and specificity should then be viewed as for "clinically significant SAH" as non-clinically significant SAH could have been missed.

	==Funding==		==Funding==

Jtolles: /* Subgroup analysis */

2014-10-07T00:57:47Z

Subgroup analysis

← Older revision		Revision as of 00:57, 7 October 2014
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	===Subgroup analysis===		===Subgroup analysis===
			Subjects who underwent head CT within 6 hours of headache onset
			* Increased sensitivity for head CT (see above) when compared to study group as a whole <br />

			Subjects who did not undergo lumbar puncture vs those who did
			* No significant difference in sex, loss of consciousness, arrival by ambulance, exertional onset, vomiting, BP, HR
			* Higher mean age: 47.1 vs 43
			* Shorter time to headache maximum intensity
			* Higher incidence of neck pain
			* Higher incidence of "worst headache ever"

	==Criticisms==		==Criticisms==

Jtolles: /* Secondary Outcomes */

2014-10-07T00:44:10Z

Secondary Outcomes

← Older revision		Revision as of 00:44, 7 October 2014
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	* To diagnose SAH based on CT, xanthochromia in CSF, or RBCs >5x10<sup>6</sup>/L in final tube of CSF collected and aneurysm identified on cerebral angiography (digital subtraction, CT, or MR angiography)		* To diagnose SAH based on CT, xanthochromia in CSF, or RBCs >5x10<sup>6</sup>/L in final tube of CSF collected and aneurysm identified on cerebral angiography (digital subtraction, CT, or MR angiography)

	===Secondary Outcomes===		===Secondary Outcomes===
			None


	===Subgroup analysis===		===Subgroup analysis===

Jtolles: /* Primary Outcomes */

2014-10-07T00:43:41Z

Primary Outcomes

← Older revision		Revision as of 00:43, 7 October 2014
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	===Primary Outcomes===		===Primary Outcomes===
	* To diagnose SAH based on CT, xanthochromia in CSF, or ~~any~~ RBCs in final tube of CSF collected ~~with positive results~~ on cerebral angiography (digital subtraction, CT, or MR angiography)		* To diagnose SAH based on CT, xanthochromia in CSF, or RBCs >5x10<sup>6</sup>/L in final tube of CSF collected and aneurysm identified on cerebral angiography (digital subtraction, CT, or MR angiography)

	===Secondary Outcomes===		===Secondary Outcomes===

Jtolles: /* Interventions */

2014-10-07T00:31:31Z

Interventions

← Older revision		Revision as of 00:31, 7 October 2014
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	*Transfer from outside hospital with confirmed diagnosis of SAH		*Transfer from outside hospital with confirmed diagnosis of SAH

	==Interventions==		==Interventions==
			Treating physicians worked up study subjects for SAH and initiated treatment per their usual clinical practice.


	==Outcome==		==Outcome==

Jtolles: /* Criticisms */

2014-10-07T00:28:03Z

Criticisms

← Older revision		Revision as of 00:28, 7 October 2014
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	==Criticisms==		==Criticisms==
			Not all study subjects underwent lumbar puncture, possibly resulting in an underestimation of the rate of false-negative CT. However, investigators endeavored to follow up all subjects at 6 months using medical records and phone calls; no patients contacted received a subsequent diagnosis of SAH. Only 50 patients could not be followed up by these methods. For these 50, review of referrals to neurosurgical centers and coroner reports failed to suggest that any had had a missed SAH.


	==Funding==		==Funding==