Benefit of cerebrospinal fluid spectrophotometry in the assessment of CT scan negative suspected subarachnoid haemorrhage: A diagnostic accuracy study

Hann, Angus, Chu, Kevin, Greenslade, Jaimi, Williams, Julian and Brown, Anthony (2014) Benefit of cerebrospinal fluid spectrophotometry in the assessment of CT scan negative suspected subarachnoid haemorrhage: A diagnostic accuracy study. Journal of Clinical Neuroscience, 22 1: 173-179. doi:10.1016/j.jocn.2014.07.025


Author Hann, Angus
Chu, Kevin
Greenslade, Jaimi
Williams, Julian
Brown, Anthony
Title Benefit of cerebrospinal fluid spectrophotometry in the assessment of CT scan negative suspected subarachnoid haemorrhage: A diagnostic accuracy study
Journal name Journal of Clinical Neuroscience   Check publisher's open access policy
ISSN 0967-5868
1532-2653
Publication date 2014-05-11
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.jocn.2014.07.025
Volume 22
Issue 1
Start page 173
End page 179
Total pages 7
Place of publication London, United Kingdom
Publisher Churchill Livingstone
Collection year 2015
Language eng
Formatted abstract
This study aimed to determine if performing cerebrospinal fluid spectrophotometry in addition to visual inspection detects more ruptured cerebral aneurysms than performing cerebrospinal fluid visual inspection alone in patients with a normal head CT scan but suspected of suffering an aneurysmal subarachnoid haemorrhage (SAH). We performed a single-centre retrospective study of patients presenting to the emergency department of a tertiary hospital who underwent both head CT scan and lumbar puncture to exclude SAH. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of an approach utilising both spectrophotometry and visual inspection (combined approach) was compared to visual inspection alone. A total of 409 patients (mean age 37.8 years, 56.2% female) were recruited and six (1.5%) had a cerebral aneurysm on angiography. The sensitivity of visual inspection was 50% (95% confidence interval [CI]: 12.4–82.6%), specificity was 99% (95% CI: 97.5–99.7%), PPV was 42.9% (95% CI: 10.4–81.3%) and NPV was 99.2% (95% CI: 97.8–99.8%). The combined approach had a sensitivity of 100% (95% CI: 54.1–100%), specificity of 79.7% (95% CI: 75.4–83.5%), PPV of 6.8% (95% CI: 2.6–14.3%) and a NPV of 100% (95% CI: 98.8–100%). The sensitivity of the combined approach was not significantly different to that of visual inspection alone (p = 0.25). Visual inspection had a significantly higher specificity than the combined approach (p < 0.01). The combined approach detected more cases of aneurysmal SAH than visual inspection alone, however the difference in sensitivity was not statistically significant. Visual xanthochromia should prompt angiography because of a superior specificity and PPV. Due to its reduced sensitivity, caution should be applied when using only visual inspection of the supernatant.
Keyword Headache
Spectrophotometry
Spinal puncture
Subarachnoid haemorrhage
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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