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Can the Ottawa Subarachnoid Haemorrhage Rule help reduce investigation rates for suspected subarachnoid haemorrhage?

      The Ottawa Subarachnoid Haemorrhage (SAH) Rule is a clinical decision tool to facilitate identification of subarachnoid haemorrhage in alert, neurologically intact adults admitted to the Emergency Department (ED) with acute non-traumatic headache. It was developed by Perry et al. on the basis of data derived from a multicentre cohort study in Canada [
      • Perry J.J.
      • Stiell I.G.
      • Sivilotti M.L.
      • Bullard M.J.
      • Hohl C.M.
      • Sutherland J.
      • et al.
      Clinical decision rules to rule out subarachnoid hemorrhage for acute headache.
      ]. It takes into account clinical features that were deemed high risk for SAH, including age ≥ 40, neck pain/stiffness, witnessed loss of consciousness, onset during exertion, thunderclap headache and limited neck flexion on examination. It had been originally purported that the tool had the potential to reduce investigation rates by approximately 10–20% [
      • Perry J.J.
      • Stiell I.G.
      • Sivilotti M.L.
      • Bullard M.J.
      • Lee J.S.
      • Eisenhauer M.
      • et al.
      High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study.
      ]. We performed an up-to-date review of the literature and present a summary of the current evidence base for the validity and usefulness of the Ottawa SAH Rule.
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