Letters Subarachnoid haemorrhage

Beware adopting rigid rules

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c7398 (Published 30 December 2010) Cite this as: BMJ 2010;341:c7398
  1. Hani Marcus, academic clinical fellow and speciality trainee neurosurgery1,
  2. David Sayer, speciality trainee neurosurgery1,
  3. Tim Harris, consultant emergency medicine and pre-hospital care, and consultant intensive care medicine12
  1. 1Royal London Hospital, London E1 1BB, UK
  2. 2Newham University Hospital, London E13 8SL, UK
  1. hani.marcus{at}gmail.com

Perry and colleagues try to identify high risk clinical characteristics for subarachnoid haemorrhage in neurologically intact patients with acute headache,1 but we caution against the rigid adoption of clinical decision rules on the basis of their findings.

Firstly, although the hallmark of spontaneous subarachnoid haemorrhage is headache reaching maximal intensity immediately …

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