FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2208910311> ?p ?o ?g. }

• W2208910311 endingPage "S84" @default.
• W2208910311 startingPage "S84" @default.
• W2208910311 abstract "Study ObjectiveThe diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture; however, in an estimated 10% to 30% of procedures that are traumatic, iatrogenic bleeding can complicate diagnosis. A clinical prediction rule has been recently proposed to differentiate between SAH and traumatic lumbar puncture with 100% sensitivity and a specificity of 91.2%. This rule is based on cerebrospinal fluid findings that included a red blood cell (RBC) count greater than 2000 × 106/L and the presence of xanthochromia. If neither of the criteria was present, aneurysmal SAHs can be excluded as a cause of headache. Our objective was to externally validate the prediction rule in two tertiary care hospital-based emergency departments (ED).MethodsThis was a retrospective, cohort analysis of consecutive adult patients presenting to the emergency departments of two academic medical centers during a four-year study period. Participants included all alert patients over 18 with an acute non-traumatic headache who underwent lumbar puncture to rule out SAH. Demographics, co-morbidity, clinical findings, diagnostic testing, and final disposition were obtained from ED records using standardized abstraction forms. A second investigator performed a blinded critical review of a random sample of 20% of the records to determine reliability using kappa statistics. Values of sensitivity, specificity, and likelihood ratio (LR) were obtained, with corresponding 95% confidence intervals (CIs). Bivariate analysis was then conducted to identify which clinical factors in our population should be further considered as potential predictors of SAH. We evaluated several alternative models using these clinical factors and compared them by their ability to distinguish between patients with and without a SAH using multivariate logistic regression.ResultsA total of 2315 patients were screened; 367 had abnormal results on cerebrospinal fluid analysis with > 1 × 106/L red blood cells in the final tube of cerebrospinal fluid and/or xanthochromia in one or more tubes. Overall, SAH was confirmed in 32 patients (8.7%) after diagnostic imaging. The presence of less than 2000 × 106/L red blood cells in addition to no xanthochromia excluded the diagnosis of aneurysmal subarachnoid hemorrhage in 326 patients, with a sensitivity of 78.1% (95% confidence interval 60.0% to 90.7%) and specificity of 97.3% (95.0% to 98.8%). Using statistical modeling, we found no risk factor or combination of clinical factors that would improve ED provider sensitivity without markedly decreasing specificity. The consistency of the data recording was excellent, with a median kappa statistic of 0.86.ConclusionsWe were unable to validate a previously described clinical prediction rule to differentiate between SAH and traumatic lumbar puncture. No single clinical finding or combination of findings carried sufficient weight to exclude the diagnosis of SAH. Study ObjectiveThe diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture; however, in an estimated 10% to 30% of procedures that are traumatic, iatrogenic bleeding can complicate diagnosis. A clinical prediction rule has been recently proposed to differentiate between SAH and traumatic lumbar puncture with 100% sensitivity and a specificity of 91.2%. This rule is based on cerebrospinal fluid findings that included a red blood cell (RBC) count greater than 2000 × 106/L and the presence of xanthochromia. If neither of the criteria was present, aneurysmal SAHs can be excluded as a cause of headache. Our objective was to externally validate the prediction rule in two tertiary care hospital-based emergency departments (ED). The diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture; however, in an estimated 10% to 30% of procedures that are traumatic, iatrogenic bleeding can complicate diagnosis. A clinical prediction rule has been recently proposed to differentiate between SAH and traumatic lumbar puncture with 100% sensitivity and a specificity of 91.2%. This rule is based on cerebrospinal fluid findings that included a red blood cell (RBC) count greater than 2000 × 106/L and the presence of xanthochromia. If neither of the criteria was present, aneurysmal SAHs can be excluded as a cause of headache. Our objective was to externally validate the prediction rule in two tertiary care hospital-based emergency departments (ED). MethodsThis was a retrospective, cohort analysis of consecutive adult patients presenting to the emergency departments of two academic medical centers during a four-year study period. Participants included all alert patients over 18 with an acute non-traumatic headache who underwent lumbar puncture to rule out SAH. Demographics, co-morbidity, clinical findings, diagnostic testing, and final disposition were obtained from ED records using standardized abstraction forms. A second investigator performed a blinded critical review of a random sample of 20% of the records to determine reliability using kappa statistics. Values of sensitivity, specificity, and likelihood ratio (LR) were obtained, with corresponding 95% confidence intervals (CIs). Bivariate analysis was then conducted to identify which clinical factors in our population should be further considered as potential predictors of SAH. We evaluated several alternative models using these clinical factors and compared them by their ability to distinguish between patients with and without a SAH using multivariate logistic regression. This was a retrospective, cohort analysis of consecutive adult patients presenting to the emergency departments of two academic medical centers during a four-year study period. Participants included all alert patients over 18 with an acute non-traumatic headache who underwent lumbar puncture to rule out SAH. Demographics, co-morbidity, clinical findings, diagnostic testing, and final disposition were obtained from ED records using standardized abstraction forms. A second investigator performed a blinded critical review of a random sample of 20% of the records to determine reliability using kappa statistics. Values of sensitivity, specificity, and likelihood ratio (LR) were obtained, with corresponding 95% confidence intervals (CIs). Bivariate analysis was then conducted to identify which clinical factors in our population should be further considered as potential predictors of SAH. We evaluated several alternative models using these clinical factors and compared them by their ability to distinguish between patients with and without a SAH using multivariate logistic regression. ResultsA total of 2315 patients were screened; 367 had abnormal results on cerebrospinal fluid analysis with > 1 × 106/L red blood cells in the final tube of cerebrospinal fluid and/or xanthochromia in one or more tubes. Overall, SAH was confirmed in 32 patients (8.7%) after diagnostic imaging. The presence of less than 2000 × 106/L red blood cells in addition to no xanthochromia excluded the diagnosis of aneurysmal subarachnoid hemorrhage in 326 patients, with a sensitivity of 78.1% (95% confidence interval 60.0% to 90.7%) and specificity of 97.3% (95.0% to 98.8%). Using statistical modeling, we found no risk factor or combination of clinical factors that would improve ED provider sensitivity without markedly decreasing specificity. The consistency of the data recording was excellent, with a median kappa statistic of 0.86. A total of 2315 patients were screened; 367 had abnormal results on cerebrospinal fluid analysis with > 1 × 106/L red blood cells in the final tube of cerebrospinal fluid and/or xanthochromia in one or more tubes. Overall, SAH was confirmed in 32 patients (8.7%) after diagnostic imaging. The presence of less than 2000 × 106/L red blood cells in addition to no xanthochromia excluded the diagnosis of aneurysmal subarachnoid hemorrhage in 326 patients, with a sensitivity of 78.1% (95% confidence interval 60.0% to 90.7%) and specificity of 97.3% (95.0% to 98.8%). Using statistical modeling, we found no risk factor or combination of clinical factors that would improve ED provider sensitivity without markedly decreasing specificity. The consistency of the data recording was excellent, with a median kappa statistic of 0.86. ConclusionsWe were unable to validate a previously described clinical prediction rule to differentiate between SAH and traumatic lumbar puncture. No single clinical finding or combination of findings carried sufficient weight to exclude the diagnosis of SAH. We were unable to validate a previously described clinical prediction rule to differentiate between SAH and traumatic lumbar puncture. No single clinical finding or combination of findings carried sufficient weight to exclude the diagnosis of SAH." @default.
• W2208910311 created "2016-06-24" @default.
• W2208910311 creator A5058139715 @default.
• W2208910311 creator A5068766594 @default.
• W2208910311 creator A5078846821 @default.
• W2208910311 creator A5082951664 @default.
• W2208910311 creator A5083336374 @default.
• W2208910311 date "2015-10-01" @default.
• W2208910311 modified "2023-10-02" @default.
• W2208910311 title "229 External Validation of a Clinical Prediction Rule for the Differentiation of Traumatic Lumbar Punctures from Aneurysmal Subarachnoid Hemorrhage" @default.
• W2208910311 doi "https://doi.org/10.1016/j.annemergmed.2015.07.262" @default.
• W2208910311 hasPublicationYear "2015" @default.
• W2208910311 type Work @default.
• W2208910311 sameAs 2208910311 @default.
• W2208910311 citedByCount "1" @default.
• W2208910311 countsByYear W22089103112022 @default.
• W2208910311 crossrefType "journal-article" @default.
• W2208910311 hasAuthorship W2208910311A5058139715 @default.
• W2208910311 hasAuthorship W2208910311A5068766594 @default.
• W2208910311 hasAuthorship W2208910311A5078846821 @default.
• W2208910311 hasAuthorship W2208910311A5082951664 @default.
• W2208910311 hasAuthorship W2208910311A5083336374 @default.
• W2208910311 hasConcept C126322002 @default.
• W2208910311 hasConcept C126838900 @default.
• W2208910311 hasConcept C141071460 @default.
• W2208910311 hasConcept C2777736543 @default.
• W2208910311 hasConcept C2779651940 @default.
• W2208910311 hasConcept C2780066322 @default.
• W2208910311 hasConcept C44575665 @default.
• W2208910311 hasConcept C71924100 @default.
• W2208910311 hasConceptScore W2208910311C126322002 @default.
• W2208910311 hasConceptScore W2208910311C126838900 @default.
• W2208910311 hasConceptScore W2208910311C141071460 @default.
• W2208910311 hasConceptScore W2208910311C2777736543 @default.
• W2208910311 hasConceptScore W2208910311C2779651940 @default.
• W2208910311 hasConceptScore W2208910311C2780066322 @default.
• W2208910311 hasConceptScore W2208910311C44575665 @default.
• W2208910311 hasConceptScore W2208910311C71924100 @default.
• W2208910311 hasIssue "4" @default.
• W2208910311 hasLocation W22089103111 @default.
• W2208910311 hasOpenAccess W2208910311 @default.
• W2208910311 hasPrimaryLocation W22089103111 @default.
• W2208910311 hasRelatedWork W1531291525 @default.
• W2208910311 hasRelatedWork W1586577281 @default.
• W2208910311 hasRelatedWork W1992759812 @default.
• W2208910311 hasRelatedWork W2011271335 @default.
• W2208910311 hasRelatedWork W2218047265 @default.
• W2208910311 hasRelatedWork W2354541436 @default.
• W2208910311 hasRelatedWork W2367748479 @default.
• W2208910311 hasRelatedWork W2368225322 @default.
• W2208910311 hasRelatedWork W2582395107 @default.
• W2208910311 hasRelatedWork W3017675213 @default.
• W2208910311 hasVolume "66" @default.
• W2208910311 isParatext "false" @default.
• W2208910311 isRetracted "false" @default.
• W2208910311 magId "2208910311" @default.
• W2208910311 workType "article" @default.