Subarachnoid haemorrhage and acute severe headache Circulatory System Subarachnoid haemorrhage and acute severe headache
Conditions
Interventions
As an observational study, there will be no change to clinical practice. Headache features will be prospectively collected. Relevant investigations of CT brain, lumbar puncture, and CT-angiogram will
Sponsors
Northern Care Alliance
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Aged =18 years 2. Presenting with a non-traumatic acute headache that reaches maximal intensity within one hour to UK Emergency Departments (ED) or equivalent acute secondary care environment
Exclusion criteria
Exclusion criteria: 1. Direct head trauma in the previous 7 days 2. Returning for reassessment of the same headache within the recruitment period 3. Established diagnosis of subarachnoid haemorrhage, brain neoplasm, ventricular shunt or hydrocephalus prior to attendance at the emergency department. 4. Focal neurological deficit 5. Headache with onset >14 days prior to attendance 6. Recurrent headaches defined as =3 headaches of similar character and intensity as presenting headache 7. Transfer from another hospital with confirmed subarachnoid haemorrhage 8. Prisoner presenting to ED/secondary care 9. Patient currently under detained Mental health act, presenting to ED/secondary care
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Current primary outcome measure as of 18/05/2021: 1. External validation of a 6-hour CT brain rule out strategy for alert (defined as awake and fully orientated or GCS 15/15) patients presenting with acute non-traumatic headache, where there is clinical concern for SAH using prospectively collected data. Previous primary outcome measure: 1. External validation of the proposed 6 h CT brain rule out strategy for alert patients (defined as awake and fully orientated or GCS 15/15) presenting with acute non-traumatic headache, suggestive of subarachnoid haemorrhage using prospectively collected data | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Change in sensitivity of CT brain imaging in patients presenting with acute severe headache over hourly intervals from 6 to 24 h after onset of headache using prospectively collected CT brain data 2. Validation of the Ottawa subarachnoid haemorrhage clinical decision rule in patients presenting with acute non-traumatic headache using prospectively collected clinical notes, primary care contact data, and HES data Added 18/05/2021: The prevalence of subarachnoid haemorrhage in patients under 40 years of age identified from the data collected as any of the following: 1. Subarachnoid blood present on unenhanced CT reported by a trained radiologist. Site CT characteristics will be collected to include minimum criteria applied for inclusion in the final analysis, as follows: 1.1. A 3rd generation multi-slice scanner (4 to 320 slices/rotation) 1.2. 5 – 7.5 mm cuts for brain 1.3. 2.5 – 5 mm cuts for the posterior fossa 2. Subarachnoid blood present on CT-angiogram or MR-angiogram reported by a trained radiologist 3. CSF findings consistent with SAH according to the 2008 National Biochemist reporting guideline. The vast majority of UK laboratories processing CSF samples adhere to the 2008 clinical biochemistry guidelines. However, for those sites identified as using xanthochromia or red blood cells in lieu of 2008 criteria, the study team will adopt criteria stipulated in the original paper by Perry et al. 4. Visible xanthochromia. Red blood cells (>5 × 10e6/l) in the final tube of cerebrospinal fluid collected and an aneurysm identified on cerebral angiography (digital subtraction, computed tomography, or magnetic resonance angiography) For patients who are evaluated for acute severe headache reaching maximal intensity within 1 hour in UK emergency departments. | — |
Countries
England, United Kingdom
Contacts
Public ContactRobert Hirst
Outcome results
None listed