Full dataset LP in SAH.xlsx

<b>ABSTRACT</b><br><b>Objectives: </b>This study sought to identify the proportion of spontaneous subarachnoid haemorrhage (SAH) patients diagnosed by Lumbar Puncture (LP). Furthermore to report the incidence of aneurysmal SAH if a CT scan performed within 6 hours was reported as negative, and finally to investigate if there has been a change in practice since the new NICE guidance for the diagnosis of SAH was published in November 2022.<br><b>Methods: </b>A pragmatic multicentre audit was conducted in the UK and Ireland capturing referrals to 25 Neurosurgical centres between 1st November 2020 - 31st October 2023. Case referral identification was done in each unit using local medical records and referral databases based on local protocols.<br><b>Results:</b><b> </b>10,187 cases of spontaneous SAH were diagnosed within the study period: 9,357 were diagnosed by CT and 717 by LP. 7% of all confirmed SAH cases underwent lumbar punctures to return a diagnosis of spontaneous SAH when a CT head scan was non-diagnostic. This yielded 213 (3%) diagnoses of aneurysmal SAH. 55 cases(1%) of aneurysmal SAH initially had negative CT head scans within 6 hours of ictus and a positive LP. We did not identify any evidence of a change in practice following the introduction of the NICE guidance in November 2022.<br><b>Conclusion: </b>1% of all diagnosed aneurysmal SAH were diagnosed by LP having initially had negative CT head scans within 6 hours of ictus. There does not appear to have been a change in practice when diagnosing suspected spontaneous SAH since the new NICE guidance was delivered in November 2022. This study shows that LP continues to be an important diagnostic test that will confirm a diagnosis of aneurysmal SAH in a small, but significant number of patients with thunderclap headache. We provide new data that may impact the current NICE guidelines on the diagnosis of SAH.<b>摘要</b><br><b>研究目的：</b>本研究旨在明确通过腰椎穿刺术（lumbar puncture, LP）确诊的自发性蛛网膜下腔出血（spontaneous subarachnoid haemorrhage, SAH）患者占比；此外，报告发病6小时内计算机断层扫描（computed tomography, CT）结果为阴性的动脉瘤性蛛网膜下腔出血（aneurysmal SAH）的发生率；最终探究自2022年11月发布新版英国国家卫生与临床优化研究所（NICE）SAH诊断指南以来，临床实践是否发生了变化。<br><b>研究方法：</b>本研究在英国与爱尔兰开展了一项实用性多中心临床审核，纳入2020年11月1日至2023年10月31日期间转诊至25家神经外科中心的病例。各中心依据本地诊疗方案，通过本地医疗记录与转诊数据库完成病例转诊识别。<br><b>研究结果：</b>研究期内共确诊10187例自发性SAH，其中9357例经CT确诊，717例经LP确诊。当头部CT扫描结果无法明确诊断时，7%的确诊自发性SAH病例通过腰椎穿刺术明确诊断。该方式累计确诊213例（占比3%）动脉瘤性SAH。另有55例（占比1%）动脉瘤性SAH患者在发病6小时内头部CT扫描结果为阴性，但腰椎穿刺结果为阳性，从而确诊。本研究未发现2022年11月NICE指南发布后，临床实践出现任何变化的证据。<br><b>研究结论：</b>所有确诊的动脉瘤性SAH患者中，有1%在发病6小时内头部CT扫描结果为阴性，最终通过腰椎穿刺术确诊。自2022年11月新版NICE指南发布以来，疑似自发性SAH的临床诊断实践似乎并未发生变化。本研究表明，腰椎穿刺术仍是一项重要的诊断手段，可在少数但不容忽视的霹雳样头痛患者中明确动脉瘤性SAH的诊断。本研究提供的全新数据或可对当前NICE发布的SAH诊断指南产生影响。