New tool iden­ti­fies headache pa­tients at risk of aneurysms

Tehran Times - - SCIENCE - (Source: eu­

A new tool to iden­tify po­ten­tially fa­tal aneurysms in pa­tients with headaches who seem other­wise well will help emer­gency de­part­ments to iden­tify high-risk pa­tients, im­prove sur­vival rates and cut out un­nec­es­sary imag­ing, ac­cord­ing to new re­search pub­lished in CMAJ (Cana­dian Med­i­cal As­so­ci­a­tion Jour­nal)

A bleed­ing brain aneurysm, re­ferred to med­i­cally as a sub­arach­noid hem­or­rhage, can cause a sud­den headache.

“Al­though rare, ac­count­ing for only 1%-3% of headaches, these brain aneurysms are deadly,” says Dr. Jef­frey Perry, an emer­gency physi­cian with The Ot­tawa Hos­pi­tal and the Univer­sity of Ot­tawa, Ot­tawa, On­tario. “Al­most half of all pa­tients with this con­di­tion die and about 2/5 of sur­vivors have per­ma­nent neu­ro­log­i­cal deficits. Pa­tients di­ag­nosed when they are alert and with only a headache have much bet­ter out­comes, but can be chal­leng­ing to di­ag­nose as they of­ten look rel­a­tively well.”

The Ot­tawa Sub­arach­noid Hem­or­rhage Rule was de­vel­oped by re­searchers at The Ot­tawa Hos­pi­tal, which also cre­ated The Ot­tawa Rules, de­ci­sion tools used in emer­gency de­part­ments around the world to iden­tify an­kle, knee and spine frac­tures.

The cur­rent study, in­volv­ing 1153 alert adult pa­tients with acute sud­den on­set headache ad­mit­ted to 6 univer­sity-af­fil­i­ated hospi­tals in Canada over 4 years from Jan­uary 2010 to 2014, val­i­dates ear­lier pub­lished re­search that ini­tially pro­posed the Ot­tawa Sub­arach­noid Hem­or­rhage Rule.

“Be­fore any clin­i­cal de­ci­sion rule can be used safely, it must be val­i­dated in new pa­tients to en­sure that the de­rived ‘rule’ did not come to be by chance, and that it is truly safe,” says Dr. Perry. “This is es­pe­cially true with a po­ten­tially life-threat­en­ing con­di­tion such as sub­arach­noid hem­or­rhage.”

The newly val­i­dated rule gives emer­gency physi­cians a re­li­able tool to iden­tify high-risk pa­tients and rule out the con­di­tion in low-risk pa­tients with­out hav­ing to or­der time-con­sum­ing imag­ing.

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