دانلود ترجمه مقاله بررسی تصمیم گیری بالینی برای خونریزی زیر عنکبوتیه در بیماران با سردرد حاد - مجله الزویر

Article history: Received 15 October 2014 Accepted 24 November 2014 Available online xxxx We aim to externally validate the Ottawa subarachnoid hemorrhage (OSAH) clinical decision rule. This rule identifies patientswith acute nontraumatic headachewho require further investigation.We conducted a medical record review of all patients presenting to the emergency department (ED)with headache fromJanuary 2011 to November 2013. Per the OSAH rule, patients with any of the following predictors require further investigation: age 40 years or older, neck pain, stiffness or limited flexion, loss of consciousness, onset during exertion, or thunderclap. The rulewas applied following theOSAHrule criteria. Patients were followed up for repeat visitswithin 7 days of initial presentation. Data were electronically harvested fromthe electronic medical record and manually abstracted fromindividual patient charts using a standardized data abstraction form. Calibration between trained reviewerswas performed periodically. A total of 5034 ED visits with acute headachewere reviewed for eligibility. There were 1521 visits that met exclusion criteria, and 3059 had headache of gradual onset or time to maximal intensity greater than or equal to 1 hour. The rule was applied to 454 patients (9.0%). There were 9 cases of subarachnoid hemorrhage (SAH), yielding an incidence of 2.0% (95% confidence interval [CI], 1.0%-3.9%) in the eligible cohort. The sensitivity for SAH was 100% (95% CI, 62.9%-100%); specificity, 7.6% (95% CI, 5.4%-10.6%); positive predictive value, 2.1% (95% CI 1.0%-4.2%); and negative predictive value, 100% (95% CI, 87.4%-100%). The OSAH rule was 100% sensitive for SAH in the eligible cohort. However, its low specificity and applicability to only a minority of ED patients with headache (9%) reduce its potential impact on practice.