1. SAH Dr. Clifford Mann FRCP FCEM
     Diagnosis in Primary care and the ED
Dr. Clifford Mann FRCP FCEM
President of the College of Emergency Medicine

2. Diagnosis in General Practice
90% of people suffer headache
4.4% of all GP consultations
1 headache patient per week
1 SAH patient per 7 years
350:1 probability

3. In this study Affected outcome in 71% of these
Diagnosis delayed in 42%
17.6% presented to GP

4. What we don’t know
How typical were the symptoms as described by the patient at first contact after the event?
How probable is it that any clinician can diagnose atypical cases when typical cases represent < 0.3% of headaches

5. Diagnosis in 2ry care
50:50 senior : Junior

6. Time of presentation Night = 12% Evening = 26% Day = 60%
With 7 day service all patients could be reviewed within 12hrs of arrival and 75% within 4 hrs

7. Often taught that the typical patient is female and young.
and more common over 50 than under 50 years of age
In fact it is more common in middle aged men than young women
Often taught that the typical patient is female and young.

8. Almost 20% had inadequate examination
Initial Assessment
Almost 20% had inadequate examination
95% had adequate history
Almost certainly due to ‘history = scan’

9. One third have motor defect One fifth have pupillary defect
Easy to assess – could easily be on a proforma for ? SAH

10. 80:20

11. 82% presented to sites without neurosurgery

12. No evidence that distance or journey time is of importance

13. Time to CT (from arrival)
1-3 hrs
> 3 hrs
<1 hr

14. LP
Only 3.6% of patients

15. Secondary Care Diagnosis