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Among patients presenting to the emergency department with acute nontraumatic headache that reached maximal intensity within 1 hour and who had normal neurologic examination findings, the Ottawa SAH Rule was highly sensitive for identifying subarachnoid hemorrhage.
In patients meeting the inclusion criteria, SAH was ruled out in the absence of:
1. age ≥40 years
2. neck pain or stiffness
3. witnessed loss of consciousness
4. onset during exertion
5. âthunderclap headacheâ (ie. instantly peaking pain)
6. limited neck flexion on examination
In the population studied the Ottawa SAH rule had 100% (95% CI, 97.2%-100.0%) sensitivity and 15.3% (95% CI, 13.8%-16.9%) specificity.
The authors note that the study results apply only to patients with the specific inclusion/exclusion criteria described and require additional evaluation in implementation studies before the rule is applied in routine clinical care.
References
Perry JJ et al
Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache
JAMA. 2013;310(12):1248-1255. doi:10.1001/jama.2013.278018.
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