Ottawa Subarachnoid Hemorrhage Rule

Aka: Ottawa Subarachnoid Hemorrhage Rule

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II. Indications

  1. New, severe non-Traumatic Headache reaching maximal intensity within one hour
  2. Age >15 years

III. Contraindications

  1. New associated neurologic deficits
  2. Cerebral Aneurysm history
  3. Malignancy history
  4. Recurrent Headache

IV. Criteria

  1. Age over 40 years old
  2. Witnessed loss of consciousness (+LR: 3.77)
  3. Neck Pain or stiffness (more suggestive of severe SAH, +LR 2.29)
  4. Limited neck flexion on exam
  5. Thunderclap headadache (severity peaks rapidly, within 15-60 minutes)
  6. Onset during exertion (Exertional Headache, +LR 2.16)

V. Interpretation

  1. All criteria absent excludes nearly 100% of Subarachnoid Hemorrhage cases
    1. Test Sensitivity: 99.5 to 100%
    2. Test Specificity: 8 to 24%

VI. References

  1. Perry (2013) JAMA 310(12): 1248-55 [PubMed]
  2. Bellolio (2015) Am J Emerg Med 33(2): 244-9 [PubMed]

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