Metro Stroke Task Force Survey of Resources for Diagnosis of Non-Traumatic Subarachnoid Hemorrhage
Background: Up to 25 percent of patients with subarachnoid hemorrhage (SAH)initially receive an incorrect diagnosis. Potential limitations to initially diagnosing SAH include insufficient resources and non-standardized utilization of existing resources. We performed a population-based study to assess adherence to recommendations regarding computed tomography (CT) scanning and cerebrospinal fluid (CSF) analysis as cited in a recent publication. Methods: We approached all hospitals with operational emergency departments within a 50 mile radius of downtown Jacksonville, FL. Each facility was contacted by phone or in person by one of two members of the Metro Stroke Task Force (SPD,SS). Included in the survey were groups of questions each directed to a physician or technician best qualified to provide appropriate information. We used the recommendations cited by Edlow and Caplan as a benchmark for diagnosing SAH acutely (cf. New Engl J Med 2000; 342:29–36). Specifically addressed were the axial imaging slice thickness on head CT and methods for analyzing cerebrospinal fluid for blood and blood products. Results: 13 of 13 (100%) hospitals responded. 7 of 13 (54%) have 200 or more beds. 10 of 13 (77%) have neurosurgeons on staff. None (0%) of the hospitals surveyed cited a specific protocol for head CT scanning or CSF analysis in the evaluation of suspected subarachnoid hemorrhage. One (7.7%) hospital used CT cuts as thin at the base of the brain as the 3mm recommended. None (0%) of the hospitals routinely used spectrophotometry to evaluate for the presence of xanthochromia in CSF when ruling out SAH. Conclusion: We found that there is not a uniform and specific way to approach the diagnosis of SAH among all of the institutions that provide acute care within a 50 mile radius of Jacksonville. Areas for improvement in delivery of care might include standardized protocols for CT acquisition and CSF analysis for blood and blood products. Such standardized measures may reduce the potential for initial diagnostic errors.