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Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department

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Abstract

Background

Subarachnoid haemorrhage (SAH) clinical decision rules can provide successful results in the differential diagnosis of non-traumatic headache.

Aim

The aim of this study is to investigate whether a laboratory parameter that can be added to clinical decision-making rules can better predict subarachnoid haemorrhages in patients presenting to the emergency department with headache.

Methods

We conducted a retrospective cohort study between March 2017 and March 2019. Patients over the age of 18 who admitted to the emergency department with non-traumatic, acute headache last 14 days before admission and evaluated by imaging and laboratory studies were included in the study.

Results

A total of 867 patients were included and 141 of them had SAH. In detecting the SAH, Ottawa SAH rule sensitivity (85.1%), specificity (47.1%), positive predictive value (PPV) (23.8%) and negative predictive value (NPV) (94.2%), and for EMERALD SAH, rule sensitivity (96.4%), specificity (43.2%), PPV (24.8%) and NPV (98.4%). In the regression analysis, statistically significant result was obtained to exclude the diagnosis of SAH with the decrease in the eosinophil value (cutoff < 0.085 10^3/µL, OR: 0.011, 95% CI: 0.001–0.213, p = 0.003). When eosinophil value was added to EMERALD SAH rule, it provided a 100% of sensitivity, a 38.4% of specificity, a 24% of PPV and a 100% of NPV in detecting the SAH.

Conclusions

EMERALD SAH rule plus eosinophil, which offers 100% sensitivity and NPV for predicting SAH in adult non-traumatic headaches, may be recommended as a successful and practical decision rule for clinical use according to the Ottawa and EMERALD SAH rule.

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Acknowledgements

All authors thank Nazif Calis, for his assistance with statistical analyses.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Adana City Training and Research Hospital, Mithat Ozhan Avenue, 01370, Yuregir, Adana, Turkey

    Adem Kaya, Salim Satar, Muge Gulen & Selen Acehan

  2. Department of Neurosurgery, Kilis State Hospital, Kilis, Turkey

    Kemal Alper Afser

  3. Department of Public Health, Çukurova University, Adana, Turkey

    Hakan Demirhindi

Authors
  1. Adem Kaya
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  2. Salim Satar
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  3. Muge Gulen
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  4. Selen Acehan
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  5. Kemal Alper Afser
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  6. Hakan Demirhindi
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Contributions

AK was the coordination researcher of the study and was concerned with study design, implementation, study monitoring, data collection and interpretation. SS was involved in study design, study monitoring and supervision and interpretation of data. MG, SA and KAA were researchers and were involved in data collection and interpretation. HD, MG and SA was involved in study design, statistical analysis and data interpretation. All authors reviewed the drafts and approved the final version of the article for submission.

Corresponding author

Correspondence to Salim Satar.

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Ethics approval

Before starting the study, an ethical approval was obtained from the Ethics Committee of the Faculty of Medicine, dated 08.03.2019 and numbered 86.

Conflict of interest

The authors declare no competing interests.

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Kaya, A., Satar, S., Gulen, M. et al. Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department. Ir J Med Sci 192, 1453–1462 (2023). https://doi.org/10.1007/s11845-022-03106-7

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  • DOI: https://doi.org/10.1007/s11845-022-03106-7

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