临床决策规则排除了急性头痛下arachnoid出血的临床决策规则
Jeffrey J Perry1, Ian G Stiell, Marco L A Sivilotti
1Department of Emergency Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. jperry@ohri.ca
JAMA
|September 26, 2013
概括
太华SAH规则准确地识别了急性头痛患者的甲状腺下出血 (SAH). 这一规则表现出高度敏感性,有助于早期发现这种严重的神经疾病.
科学领域:
- 神经学 神经学
- 紧急医疗 紧急医疗
- 诊断的准确性 诊断的准确性
背景情况:
- 脑下关节下出血 (SAH) 是一种严重的疾病,通常伴有急性头痛.
- 临床决策规则旨在确定需要进一步调查SAH的患者.
- 以前的规则要求在不同患者队列中进行验证.
研究的目的:
- 评估现有的临床决策规则的准确性,可靠性和潜在的改进,以确定SAH.
- 评估这些规则在急诊室急性头痛患者的新队列中的表现.
- 制定一个改进的规则,即太华SAH规则,以提高诊断灵敏度.
主要方法:
- 一项多中心队列研究,涉及2131名成年患者,急性头痛在1小时内达到峰值,并且没有神经缺陷.
- 数据由加拿大10个第三级护理急诊部的医生收集.
- 对SAH的诊断标准包括CT扫描,脑脊液分析和血管学.
主要成果:
- 在6.2%的被录取患者中,甲下关节出血被证实.
- 结合年龄,部疼痛/硬,目击意识丧失或运动开始的规则显示,SAH的敏感度为98.5%.
- 经过改进的太华SAH规则,添加了"雷击头痛"和"有限的部曲",实现了SAH100%的灵敏度.
结论:
- 太华SAH规则在特定急性头痛呈现时识别子关节下出血时非常敏感.
- 这一规则对于急诊室对患有急性非创伤性头痛的患者进行分拣非常有价值.
- 在常规临床采用之前,建议进行进一步的实施研究.
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