Subarachnoid hemorrhage clinical prediction rules

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Clinical predication rules for diagnosing subarachnoid hemorrhage have been systematically reviewed.

The Ottawa SAH Rule

The Ottawa SAH Rule

• "For alert patients older than 15 y with new severe nontraumatic headache reaching maximum intensity within 1 hour"

• "Not for patients with new neurologic deficits, previous aneurysms, SAH, brain tumors, or history of recurrent headaches (≥3 episodes over the course of ≥6 months)"

Investigate if ≥1 high-risk variables present:

1. Age ≥ 40 years
2. Neck pain or stiffness
3. Witnessed loss of consciousness
4. Onset during exertion
5. Thunderclap headache (instantly peaking pain)
6. Limited neck flexion on examination

This rule has accuracy of:

• Sensitivity: 100%
• Specificity : 15%