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The use of CT angiography in acute subarachnoid haemorrhage in Eastern Scotland
P White1, R Macpherson, R Sellar
1Department of Neuroradiology, Western General Hospital, Edinburgh, UK. pmw@skull.dcn.ed.ac.uk
Insights
Immediate CT Angiography (CTA) after subarachnoid hemorrhage (SAH) diagnosis can significantly reduce delays in aneurysm treatment. This expedited imaging approach aims to minimize rebleeding risks and improve patient outcomes.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subarachnoid hemorrhage (SAH) requires prompt diagnosis of its aneurysmal cause to minimize rebleeding risk.
- CT Angiography (CTA) is the primary diagnostic tool for SAH in most UK regions.
- Assessing CTA's role in the East of Scotland is crucial for understanding imaging delays.
Purpose of the Study:
- To evaluate the utilization of CTA for diagnosing the cause of SAH in the East of Scotland.
- To determine the impact of imaging delays on the overall time from ictus to aneurysm treatment.
Main Methods:
- A prospective audit of aneurysmal SAH admissions was conducted over three months.
- Data collected included time from SAH diagnosis to aneurysm imaging (CTA/DSA) and time to treatment.
- Patient transfers to a neuroscience center were noted as a factor in delays.
Main Results:
- Twenty-nine patients with aneurysmal SAH were audited.
- Only four patients received timely CTA post-diagnosis; 25 experienced significant delays.
- Average excess delays were 17 hours for CTA and 72 hours for DSA.
Conclusions:
- CTA is an accurate and accessible method for identifying SAH causes.
- Immediate CTA post-SAH confirmation could shorten treatment delays by up to 64%.
- Implementing immediate CTA may reduce poor outcomes following SAH in the East of Scotland.
Introduction:
Early confirmation of aneurysmal cause for SAH can expedite patient management and thus minimise rebleed risk. CT Angiography is the first-line method for diagnosing the cause of SAH in most UK regions. We wanted to assess the use of CTA in this context in the East of Scotland and determine how imaging delays contribute to overall delay from ictus to aneurysm treatment.
Methods:
A prospective audit of aneurysmal SAH admissions over a three month period to the Neurosciences Unit in Edinburgh was performed. The time from diagnosis of SAH to aneurysm imaging with CTA and/or DSA and time from aneurysm confirmation to definitive treatment was ascertained.
Results:
Twenty nine patients with aneurysmal SAH were admitted during the audit. Four patients had CTA expeditiously after SAH was diagnosed; the remaining 25 patients had a substantially greater wait for aneurysm imaging, involving transfer to a neuroscience centre. Average excess delay was 17 hours for CTA (72 hours for DSA).
Discussion:
CTA widely available and accurate method of determining the cause of SAH. Performing immediate CTA after SAH is confirmed could reduce delays to aneurysm treatment by up to 64%. By thus reducing rebleeds post SAH, immediate CTA could reduce poor outcomes in the East of Scotland.
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