Evidence-Based Approach To Diagnosis And Management Of Aneurysmal Subarachnoid Hemorrhage In The Emergency Department
Headache is the presenting complaint in roughly 2% of ED visits. Of all those with headache, about 1% will have SAH, meaning 99% of ED headache patients do not have SAH. This makes selecting those patients a major diagnostic challenge. Among those with sudden-onset, severe headache with normal neurologic examination, 10% to 16% have SAH. Diagnosing and accurately managing SAH remain pressing challenges for emergency clinicians. Estimates of misdiagnosis, previously as high as 32%, are now thought to be lower but still range from 5% to 15%. Patients with delayed diagnosis have worse outcomes, highlighting the importance of early recognition. Unfortunately, SAH claims the lives of 40% of its victims and leaves 30% with substantial neurological disability.
