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Postgrad Med J 2004;80:27-30 doi:10.1136/pmj.2003.005918
  • Original article

How well do we investigate patients with suspected subarachnoid haemorrhage? The continuing need for cerebrospinal fluid investigations

  1. M L A Schofield1,
  2. E Lorenz1,
  3. T J Hodgson1,
  4. S Yates2,
  5. P D Griffiths3
  1. 1Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK
  2. 2Barnsley District Hospital, Barnsley, UK
  3. 3Academic Unit of Radiology, University of Sheffield, Sheffield, UK
  1. Correspondence to:
 Professor Paul D Griffiths
 Academic Unit of Radiology, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; P.GriffithsSheffield.ac.uk
  • Received 30 January 2003
  • Accepted 17 May 2003

Abstract

Objective: To demonstrate the extent of compliance with established guidelines for the investigation of suspected subarachnoid haemorrhage (SAH) and the implications of non-compliance.

Design: Prospective observational study of practice in three hospitals in the Trent region.

Setting: One teaching hospital with a tertiary neuroscience referral centre and two large district general hospitals.

Participants: 50 consecutive patients from each centre referred for suspected SAH with negative computed tomography.

Main outcome measures: Diagnosis of SAH confirmed or excluded according to guidelines.

Results: When the data from the three centres were combined (n = 150 computed tomography negative cases) cerebrospinal fluid (CSF) investigation was not performed in 60/150 (40%). In the 90 cases where CSF studies were performed SAH was confirmed in 11 (12%).

Conclusion: There is significant non-compliance in following the established guidelines for the investigation of SAH at the centres studied. As the primary cause of non-traumatic SAH is ruptured aneurysm, which is associated with high morbidity and mortality from second haemorrhage, this highlights a major source of concern for clinical governance.

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