Screening subarachnoid hemorrhage using plasma brain natriuretic peptide in the emergency department

Abstract

Study objectives: Subarachnoid hemorrhage (SAH) may be fatal, so accurate early diagnosis is critical for emergency physicians. Some investigators showed that brain natriuretic peptide (BNP) plasma levels were elevated shortly after SAH. The purpose of this study is to investigate the usefulness of plasma BNP to screen SAH in patients with headache. Methods: We prospectively studied 36 patients with severe headache suspicious for SAH from November 2003 to April 2004. BNP plasma levels were measured only once immediately on arrival to the emergency department (ED). Patients with congestive heart failure and chronic renal failure were excluded in this study. SAH patients were finally confirmed by computed tomography (CT) scan and CT angiography. The Hunt-Hess score, Fisher's grading, and location of ruptured aneurysm were recorded for the patients with SAH. Results: Among 36 patients, 28 were diagnosed with SAH, and the remaining 8 were not. Eleven patients were male and 25 were female, so the male:female patient ratio was approximately 1:2. The mean age of patients was 54.75±15.2 years. BNP of 15 pmol/L or greater predicted acute SAH with a sensitivity of 85.7% and a specificity of 87.5% (P<.001). The BNP plasma levels in patients with SAH were not significantly related to severity (Hunt-Hess score at ED; P=.397). The BNP plasma levels in patients with SAH were not significantly related to the amount of hemorrhage (Fisher's grade) and location of the ruptured aneurysm (P=.325, P=.449, respectively). Conclusion: The BNP plasma levels may be helpful to screen SAH in patients with headache who visit the ED. Study objectives: Subarachnoid hemorrhage (SAH) may be fatal, so accurate early diagnosis is critical for emergency physicians. Some investigators showed that brain natriuretic peptide (BNP) plasma levels were elevated shortly after SAH. The purpose of this study is to investigate the usefulness of plasma BNP to screen SAH in patients with headache. Methods: We prospectively studied 36 patients with severe headache suspicious for SAH from November 2003 to April 2004. BNP plasma levels were measured only once immediately on arrival to the emergency department (ED). Patients with congestive heart failure and chronic renal failure were excluded in this study. SAH patients were finally confirmed by computed tomography (CT) scan and CT angiography. The Hunt-Hess score, Fisher's grading, and location of ruptured aneurysm were recorded for the patients with SAH. Results: Among 36 patients, 28 were diagnosed with SAH, and the remaining 8 were not. Eleven patients were male and 25 were female, so the male:female patient ratio was approximately 1:2. The mean age of patients was 54.75±15.2 years. BNP of 15 pmol/L or greater predicted acute SAH with a sensitivity of 85.7% and a specificity of 87.5% (P<.001). The BNP plasma levels in patients with SAH were not significantly related to severity (Hunt-Hess score at ED; P=.397). The BNP plasma levels in patients with SAH were not significantly related to the amount of hemorrhage (Fisher's grade) and location of the ruptured aneurysm (P=.325, P=.449, respectively). Conclusion: The BNP plasma levels may be helpful to screen SAH in patients with headache who visit the ED.