Document Detail

Should spectrophotometry be used to identify xanthochromia in the cerebrospinal fluid of alert patients suspected of having subarachnoid hemorrhage?
MedLine Citation:
PMID:  16946154     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The absence of xanthochromia in the cerebrospinal fluid (CSF) is often used to exclude subarachnoid hemorrhage (SAH). Authorities advocate spectrophotometry to measure xanthochromia, but most North American hospitals use visual inspection. We studied the diagnostic accuracy of spectrophotometry for SAH, and its potential impact on current practice. METHODS: This was a prospective cohort study comparing the diagnostic accuracy of tests. The study was set in 3 university-affiliated tertiary care emergency departments. We enrolled consecutive neurologically intact adults with nontraumatic headache undergoing lumbar puncture (LP) to rule out SAH. CSF was centrifuged, frozen and analyzed later in batch. SAH was defined by (1) subarachnoid blood on CT, (2) >5x10(6) red blood cells/L in the final CSF tube and positive angiography, or (3) visible xanthochromia in CSF and positive angiography. All subjects lacking a normal CT and LP were telephoned at 30 days. RESULTS: We enrolled 220 patients (mean age 42+/-16 years; CT rate 87.7%; angiography rate 5.9%). Two SAHs were identified: 1 with red blood cells without xanthochromia in the CSF and 1 with visibly xanthochromic CSF. The specificity of xanthochromia was 97% (95% CI: 92% to 99%) for visual inspection, but as low as 29% (95% CI: 23% to 35%) for 2 of the spectrophotometric definitions. Introducing spectrophotometry could lead to angiography in as many as 11% to 71% of patients undergoing LP. CONCLUSIONS: Spectrophotometric definitions of xanthochromia have only moderate to low specificity for SAH. Using spectrophotometry could increase angiography rates, thereby identifying more incidental aneurysms, increasing patient anxiety and exposing patients to unnecessary surgical or investigational complications without benefit.
Jeffrey J Perry; Marco L A Sivilotti; Ian G Stiell; George A Wells; Jenny Raymond; Melodie Mortensen; Cheryl Symington
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2006-08-31
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  37     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-26     Completed Date:  2006-10-13     Revised Date:  2007-11-13    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2467-72     Citation Subset:  IM    
Department of Emergency Medicine, University of Ottawa, ON, Canada.
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MeSH Terms
Cerebral Angiography
Cohort Studies
False Positive Reactions
Headache / cerebrospinal fluid
Intracranial Aneurysm / complications
Middle Aged
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Spinal Puncture
Subarachnoid Hemorrhage / cerebrospinal fluid*,  radiography
Tomography, X-Ray Computed
Comment In:
Stroke. 2007 Sep;38(9):e86; author reply e87   [PMID:  17673728 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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