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Revue de littérature et dérivation d’un algorithme clinique diagnostique pour une suspicion d’hémorragie sous-arachnoïdienne

Literature review and derivation of a diagnostic algorithm for the clinical suspicion of a subarachnoid hemorrhage

  • Article Original / Original Article
  • Published:
Annales françaises de médecine d'urgence

Résumé

Objectif

Proposer un algorithme diagnostique rationnalisant l’utilisation de la ponction lombaire (PL) dans le diagnostic de l’hémorragie sous-arachnoïdienne (HSA) et ne la réservant qu’aux patients à haut risque.

Méthode

Nous avons effectué une revue extensive de la littérature de 2009 à 2014, dans la base de données Medline/Pubmed, avec les termes Aneurysmal Subarachnoid Hemorrhage (MeSH Term) et Diagnosis (MeSH Term) et nous avons dérivé de ces résultats un algorithme diagnostique intégrant les aspects cliniques, l’imagerie par tomodensitométrie (TDM) et la recherche de xanthochromie par PL.

Résultats

Mille neuf cent quatre articles ont été identifiés, dont quatre-vingt dix-huit ont été inclus dans l’analyse. De cette analyse a été dérivé un algorithme diagnostique d’une céphalée suspecte d’HSA, avec indication au recours à la PL selon la probabilité clinique intégrant le délai depuis l’apparition des symptômes et le score d’Ottawa notamment.

Conclusions

La PL avec recherche de xanthochromie garde sa place dans le diagnostic de l’HSA, mais son utilisation peut être rationnalisée. L’algorithme proposé ne la réserve qu’aux patients à haut risque, notamment lorsque les performances de l’imagerie ne sont plus assez bonnes.

Abstract

Aim

To provide a diagnostic algorithm rationalising the use of lumbar puncture in the diagnosis of subarachnoid hemorrhage and reserving it only to high risk patients.

Procedure

A thorough review of the literature from 2009 to 2014, in Medline/PubMed database, under the search terms “aneurysmal subarachnoid haemorrhage” (MeSH) and “diagnosis” (MeSH) was performed. A probabilistic diagnostic algorithm was derived from this data, integrating clinical aspects, CT imaging and xanthochromia.

Results

1904 articles were analysed, 98 of which were used for the derivation of the clinical diagnostic algorithm of a SAH suspicion, including indication for LP based on clinical probability, and integrating time of onset of the symptoms and the Ottawa’s score.

Conclusions

A LP with search for xanthochromia keeps its place in the diagnosis of an SAH, but its use can be rationalised. Our algorithm includes LP only for high-risk patients, especially when the optimal imaging threshold is excedeed.

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  1. Service des urgences, centre hospitalier universitaire Vaudois (CHUV), 1011, Lausanne, Suisse

    C. Bianchi, D. Clerc & B. Yersin

  2. Université de Lausanne, Lausanne, Suisse

    B. Yersin

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  1. C. Bianchi
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Bianchi, C., Clerc, D. & Yersin, B. Revue de littérature et dérivation d’un algorithme clinique diagnostique pour une suspicion d’hémorragie sous-arachnoïdienne. Ann. Fr. Med. Urgence 7, 97–105 (2017). https://doi.org/10.1007/s13341-017-0727-3

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  • DOI: https://doi.org/10.1007/s13341-017-0727-3

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