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Lumbar Puncture First? An old test and a new approach to lone acute sudden headaches

Published online by Cambridge University Press:  21 May 2015

Michael J. Schull
Michael J. Schull*
Affiliation:
Clinical Epidemiology Unit and Emergency Department, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Toronto, Ont.
*
Clinical Epidemiology Unit, Sunnybrook and Women’s College Health Sciences Centre, G-140, 2075 Bayview Ave., Toronto ON M4N 3M5; [email protected]

Résumé:

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On évoque souvent le diagnostic de l’hémorragie sous-arachnoïdienne chez les patients qui se présentent à l’urgence pour un mal de tête violent et soudain, mais dont l’examen physique est normal. La norme de soins de nos jours consiste à soumettre ces patients à une tomodensitométrie (TDM) sans substance de contraste suivie d’une ponction lombaire pour les TDM négatives. Cependant, comme la plupart des céphalées évaluées sont bénignes, la plupart des résultats de la TDM et de la ponction lombaire sont normaux.

Le présent article a pour but d’analyser l’impact d’un protocole diagnostique de rechange, où la ponction lombaire serait la première (et dans la plupart des cas, la seule) épreuve diagnostique effectuée chez les patients chez qui l’on soupçonne une hémorragie sous-arachnoïdienne et qui présentent ce symptôme isolé de mal de tête violent. Selon une hypothèse raisonnable, pour chaque 100 patients évalués, le protocole de «ponction lombaire en premier» nécessiterait 81 TDM de moins et seulement 9 ponctions lombaires additionnelles, comparativement à la stratégie diagnostique traditionnelle. Ces avantages demeurent stables même en variant les hypothèses à l’intérieur des limites cliniquement plausibles.

Nous croyons que ce protocole pourrait entraîner une utilisation beaucoup plus efficace des ressources en limitant le taux de morbidité additionnel, tout en offrant une précision diagnostique équivalente pour l’hémorragie sous-arachnoïdienne chez le patient à l’urgence qui répond au critère de mal de tête isolé violent et soudain.

Type
Commentary • Commentaire
Information
Canadian Journal of Emergency Medicine , Volume 1 , Issue 2 , July 1999 , pp. 99 - 102
Copyright
Copyright © Canadian Association of Emergency Physicians 1999

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