• Jeffrey J Perry, Ian G Stiell, Marco L A Sivilotti, Michael J Bullard, Marcel Emond, Cheryl Symington, Jane Sutherland, Andrew Worster, Corinne Hohl, Jacques S Lee, Mary A Eisenhauer, Melodie Mortensen, Duncan Mackey, Merril Pauls, Howard Lesiuk, and George A Wells.
• Department of Emergency Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada. jperry@ohri.ca
• BMJ. 2011 Jan 1;343:d4277.

ObjectiveTo measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset.DesignProspective cohort study.Setting11 tertiary care emergency departments across Canada, 2000-9.ParticipantsNeurologically intact adults with a new acute headache peaking in intensity within one hour of onset in whom a computed tomography was ordered by the treating physician to rule out subarachnoid haemorrhage.Main Outcome MeasuresSubarachnoid haemorrhage was defined by any of subarachnoid blood on computed tomography, xanthochromia in cerebrospinal fluid, or any red blood cells in final tube of cerebrospinal fluid collected with positive results on cerebral angiography.ResultsOf the 3132 patients enrolled (mean age 45.1, 2571 (82.1%) with worst headache ever), 240 had subarachnoid haemorrhage (7.7%). The sensitivity of computed tomography overall for subarachnoid haemorrhage was 92.9% (95% confidence interval 89.0% to 95.5%), the specificity was 100% (99.9% to 100%), the negative predictive value was 99.4% (99.1% to 99.6%), and the positive predictive value was 100% (98.3% to 100%). For the 953 patients scanned within six hours of headache onset, all 121 patients with subarachnoid haemorrhage were identified by computed tomography, yielding a sensitivity of 100% (97.0% to 100.0%), specificity of 100% (99.5% to 100%), negative predictive value of 100% (99.5% to 100%), and positive predictive value of 100% (96.9% to 100%).ConclusionModern third generation computed tomography is extremely sensitive in identifying subarachnoid haemorrhage when it is carried out within six hours of headache onset and interpreted by a qualified radiologist.

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