{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T04:28:24Z","timestamp":1772512104448,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T00:00:00Z","timestamp":1584662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The diagnostic approach for patients presenting to EDs with headaches suspicious for subarachnoid haemorrhage (SAH) remains challenging. Modern third\u2010generation 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\u2010consuming 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\u2010contrast CT scan of the brain, as well as addressing the knowledge gap in regard to rational diagnostics among clinicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We 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\u2010up period of 6 months was chosen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LP 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.13502","type":"journal-article","created":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T18:22:31Z","timestamp":1584728551000},"page":"756-762","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Utility of lumbar puncture after a normal brain computed tomography scan in patients presenting to the emergency department with suspected subarachnoid haemorrhage: A new more rational approach?"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8546-8512","authenticated-orcid":false,"given":"Pourya","family":"Pouryahya","sequence":"first","affiliation":[{"name":"Emergency Department, Casey Hospital Program of Emergency Medicine, Monash Health  Melbourne Victoria Australia"},{"name":"Monash Emergency Research Collaborative, School of Clinical Sciences, Monash Health Monash University  Melbourne Victoria Australia"},{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Haydon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"},{"name":"Emergency Department, Monash Medical Centre Program of Emergency Medicine, Monash Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alastair","family":"Meyer","sequence":"additional","affiliation":[{"name":"Emergency Department, Casey Hospital Program of Emergency Medicine, Monash Health  Melbourne Victoria Australia"},{"name":"Monash Emergency Research Collaborative, School of Clinical Sciences, Monash Health Monash University  Melbourne Victoria Australia"},{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Easaw\u2010Mamutil","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shawn Yan Zhi","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn Hui Wen","family":"Teng","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nursing and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,3,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra052732"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12984"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12811"},{"key":"e_1_2_7_5_1","first-page":"297","article-title":"Worst headache and subarachnoid hemorrhage","volume":"32","author":"Morgenstern LB","year":"1998","journal-title":"Ann. 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