• Pourya Pouryahya, Richard Haydon, Alastair Meyer, Naomi Easaw-Mamutil, Shawn Yan Zhi Tan, and Glenn Hui Wen Teng.
• Emergency Department, Casey Hospital, Program of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2020 Oct 1; 32 (5): 756-762.

ObjectiveThe diagnostic approach for patients presenting to EDs with headaches suspicious for subarachnoid haemorrhage (SAH) remains challenging. Modern third-generation computed tomography (CT) has been shown to be extremely sensitive in identifying SAH and may eliminate the need for lumbar puncture (LP) which is an invasive, time-consuming procedure with limited accuracy and complications. The aim of this study is to assess the utility of LP in patients being evaluated for possible SAH in the ED after a negative non-contrast CT scan of the brain, as well as addressing the knowledge gap in regard to rational diagnostics among clinicians.MethodsWe conducted a retrospective data analysis of patients being evaluated for possible SAH between June 2013 and June 2018 across three EDs in Victoria, Australia. A diagnosis of SAH was defined by SAH on CT or an abnormal cerebrospinal fluid result in conjunction with positive results on cerebral angiography. A follow-up period of 6 months was chosen.ResultsA total of 4407 patients met inclusion criteria; 397 (9%) patients were diagnosed with SAH on CT. A total of 388 patients underwent LP and 778 were admitted to hospital for further investigations and management. A total of 2613 patients discharged from ED without LP remained well at 6 months from their initial presentation, but 230 cases were lost to follow up. One patient died from haemorrhagic stroke during his third hospitalisation. A single patient demonstrated a true positive LP after a normal CT brain.ConclusionLP is not required in all patients with suspected SAH who have a negative CT scan. There are defining patient characteristics that can be used to risk stratify patients and may eliminate the need for LP.© 2020 Australasian College for Emergency Medicine.

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