Lumbar puncture first: An alternative model for the investigation of lone acute sudden headache

Subarachnoid hemorrhage (SAH) is a diagnosis often considered in patients p resenting to the ED with acute sudden headaches, but with normal physical e xaminations. Standard of care today is for these patients to be investigate d by noncontrast CT scan followed by lumbar puncture (LP) for negative CTs. However, given that most investigated patients have benign headaches, most of the CT and LP results are normal. The authors studied, by means of a th eoretical analysis, the impact of an alternative diagnostic model, in which LP would be the first (and, in most cases, only) diagnostic test for patie nts suspected of SAH who meet lone acute sudden headache (LASH) criteria. G iven reasonable assumptions, for every 100 patients investigated, the "LP-f irst" model would result in 79 to 83 fewer CT scans and only seven to 11 ad ditional LPs, as compared with traditional strategies. Among ED headache pa tients meeting LASH criteria, the authors believe use of this model could r esult in more efficient use of resources, minimal additional morbidity, and equal diagnostic accuracy for SAH.