Urgent and out-of-hours CT brain undertaken to identify subarachnoid haemorrhage (SAH) or contra-indications to subsequent lumbar puncture (LP).
A significant number of urgent or out-of-hours requests for CT brain are made to identify a visible SAH. Normal CT brain examinations then usually require LP. This is dependent on a normal CT scan. All current national guidance requires a LP following a normal CT brain (Ref.1-7). This should be carried out with a degree of clinical urgency but should not be performed within 12 hours of onset of headache.
In all cases where patients undergo urgent or out-of-hours CT as a prerequisite for proceeding to a LP, if CT does not reveal either a contraindication to LP or any finding rendering LP unnecessary, then an LP should be performed no sooner than 12 hours from the onset of symptoms ( Ref 8, 11, 13.)
• Cases in which patients undergo urgent or out-of-hours CT for SAH as a prerequisite for proceeding to an LP and the CT does not reveal either a contraindication to LP, or any finding rendering LP unnecessary
• Percentage who actually undergo the LP and have the LP results available no sooner than 12 hours from headache onset.
For each patient:
• Whether appropriate clinical details are included in the request (e.g. timing of headache onset, sign of raised intracranial pressure, GCS, focal neurological deficits)
• The time of the CT examination
• Whether a SAH is demonstrated
• Whether the CT reveals a contraindication to LP
• If and when the LP was performed
• The result of the report on the LP
• The result and time of the report on the LP
40 consecutive requests.
• Discuss the audit results with radiologists and clinical referring teams
• Reinforce the local guidelines for CT urgent requests
• Clinicians must be aware that a normal CT does not exclude raised intra-cranial pressure and clinical findings need also to be taken into account
• Agree with clinicians that only a consultant or a specialist registrar at year 3 or higher can request an urgent CT scan in these circumstances
- Review of request forms
- Review of patients’ notes / discharge letters
- Review of laboratory log books
- Radiologist (8 hours)
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