Analysis of cerebrospinal fluid for xanthochromia versus modern CT scanners in the diagnosis of subarachnoid haemorrhage: Experience at a tertiary trauma referral centre.
BACKGROUND: Diagnosis of subarachnoid haemorrhage (SAH), a neurosurgical emergency in patients with headache remains a logistical challenge. The rationale of the traditional pathway of cerebrospinal fluid (CSF) xanthochromia analysis following negative Computed Tomography (CT) head scans to exclude SAH has been challenged by the increasing accuracy of modern CT scanners.
AIM: We set out to establish whether our xanthochromia service was adding value to the diagnostic pathway for SAH or whether it was acting merely as a supportive test.
METHOD: A retrospective audit of all CSF requests received since the inception of Xanthochromia service at a tertiary trauma centre. Cases interpreted as being consistent with SAH based on CSF xanthochromia analysis were selected for in depth review from the total number of cases.
RESULTS: In total 660 requests were received for CSF xanthochromia between August 2009 and July 2012. A total 28 of these were interpreted as being consistent with SAH. Only 18(64.3%) of requests were deemed appropriate as the clinical presentation in the remaining 10(35.7%) was strongly suggestive of other causes of headache. A final clinical diagnosis of SAH was made in 11 of the 18 patients who had CSF xanthochromia requested appropriately. From these 11; five (45%) were deemed initially CT negative and CSF analysis led to final correct diagnosis of SAH and appropriate surgical management.
CONCLUSION: Despite improved CT scanning technology, CSF xanthochromia interpretation aides in the definitive diagnosis of SAH. When requested appropriately CSF xanthochromia analysis remains a vital service as results impact on clinical decision making, especially when CT scan results are equivocal and is also important in later presenting patients when CT accuracy decreases.
KEYWORDS: Subarachnoid Haemorrhage, Cerebrospinal Fluid, Xanthochromia, Computed Tomography.
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Published: Annals of Clinical Biochemistry, published online on March 12, 2015 DOI:10.1177/0004563215579454