Related Experiment Videos
Validation of family history in subarachnoid hemorrhage
J E Bromberg1, G J Rinkel, A Algra
1University Department of Neurology, Utrecht, Netherlands.
Insights
Family history alone is not accurate enough to diagnose subarachnoid hemorrhage (SAH). This study found that relying on family history for SAH diagnosis has low sensitivity and predictive value.
Area of Science:
- Neurology
- Genetics
- Public Health
Background:
- Familial aggregation of subarachnoid hemorrhage (SAH) occurs in 6-9% of cases.
- Familial SAH cases often have a worse prognosis than sporadic cases, prompting screening questions.
- Family history is frequently the sole indicator of SAH when relatives have deceased from it.
Purpose of the Study:
- To evaluate the sensitivity and predictive value of family history for diagnosing subarachnoid hemorrhage (SAH).
- To determine if family history alone is sufficient for diagnosing familial SAH.
Main Methods:
- Next of kin were interviewed for patients deceased from subarachnoid hemorrhage (SAH), intracerebral hemorrhage, or ischemic stroke.
- Diagnoses from next of kin were compared against confirmed medical diagnoses (CT scans).
Main Results:
- The positive predictive value of probable SAH from family history was 0.7 (0.6 adjusted).
- The sensitivity of SAH diagnosis based on family history was 0.5.
- Ten out of 20 SAH cases were not identified through family history alone.
Conclusions:
- Family history, without medical document confirmation, is an unreliable tool for diagnosing familial subarachnoid hemorrhage (SAH).
- Further diagnostic confirmation is necessary when SAH is suspected based on family history.
Background And Purpose:
In 6% to 9% of patients with subarachnoid hemorrhage (SAH), familial aggregation occurs; truly familial cases carry a worse prognosis than sporadic cases and raise the question of screening. If relatives have died from SAH, the family history is often the only available clue to the diagnosis, but the sensitivity and predictive value of such a history for SAH are unknown.
Methods:
We contacted a next of kin for a consecutive series of patients who had died in the hospital of subarachnoid hemorrhage (n=20), intracerebral hemorrhage (n=22), or ischemic stroke (n=23) between 3 and 5 years previously, and we compared the diagnosis based on the history from this next of kin with the medical diagnosis confirmed by a CT scan.
Results:
The positive predictive value of the diagnosis of "probable SAH" from the history in our study sample was 0.7; when adjusted for incidence rates in the general population it was 0.6 (95% confidence interval, 0.3 to 0.8). The sensitivity of the diagnosis based on the history was 0.5 (95% confidence interval. 0.3 to 0.7); 10 of the 20 cases of SAH were not identified.
Conclusions:
The family history of SAH, without confirmation from medical documents, is an insufficiently accurate tool to prove or disprove the diagnosis of familial SAH.