Spontaneous Subarachnoid Hemorrhage: A Best-Practice Approach to Identification and Management in the ED - Stroke EXTRA Supplement

Points & Pearls Excerpt

• Patients presenting with acute onset of severe headache that is described as the “worst headache ever,” with a time to peak of seconds, and associated nausea, vomiting, and focal deficits are typically candidates for sSAH workup.
• It is important to emphasize that in patients with normal physical examinations, there are no significant features of the headache that allow reliable distinction between SAH and headaches of benign etiology.
• The current ACEP clinical policy states that, in some adult patients presenting to the ED with an acute headache, the Ottawa Subarachnoid Hemorrhage Rule may be used to avoid imaging in patients who are aged <40 years with no neck pain or stiffness, no loss of consciousness, no thunderclap headache, no onset with exertion, and a normal neurologic examination.
• In patients who do not meet criteria to rule out sSAH based on the Ottawa Subarachnoid Hemorrhage Rule, a noncontrast head CT should be the initial evaluation.