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J Korean Soc Emerg Med > Volume 29(4); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(4): 371-379.
급성 두통환자의 거미막밑출혈 예측을 위한 호중구/림프구 비율 및 임상 예측 지표방법의 유용성
김경훈1 , 박상오1 , 김종원1, 이경룡1, 홍대영1, 백광제1, 김신영1, 김진용2
1건국대학교병원 응급의학과
2건국대학교 충주병원 응급의학과
Efficacy of neutrophil-lymphocyte ratio and clinical predicting indexes on differentiating subarachnoid hemorrhage from acute headache patients at emergency department
Kyunghoon Kim1 , Sang O Park1 , Jong Won Kim1, Kyeong Ryong Lee1, Dae Young Hong1, Kwang Je Baek1, Sin Young Kim1, Jin Yong Kim2
1Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
2Department of Emergency Medicine, Konkuk University Chungju Hospital, Chungju, Korea
Correspondence  Jin Yong Kim ,Tel: 043-840-8331, Fax: 043-840-8962, Email: palenova@naver.com,
Received: May 18, 2018; Revised: July 11, 2018   Accepted: July 16, 2018.  Published online: August 31, 2018.
This study evaluated the clinical usefulness of the neutrophil-lymphocyte ratio (NLR), Ottawa subarachnoid hemorrhage (SAH) rule and EMERALD (Emergency Medicine, Registry Analysis, Learning and Diagnosis) SAH rule for predicting SAH in patients with acute headache.
This clinical retrospective study was conducted at an urban emergency department between January 2008 and December 2017. Alert, neurologically intact adult patients with acute headache were included. All data were drawn from electrical medical charts. The Ottawa SAH rule (positive if any of age ≥40, neck pain, loss of consciousness, onset during exertion, thunderclap headache, and neck stiffness), EMERALD SAH rule (positive if any of systolic blood pressure >150 mmHg, diastolic blood pressure >90 mmHg, serum glucose >115 mg/dL, or serum potassium <3.9 mEq/L) and NLR were assessed. The sensitivity and specificity of these tools for detecting or ruling out SAH was calculated.
Among the 1,230 patients enrolled in this study, 299 (24.3%) were diagnosed with SAH. To predict SAH, the Ottawa SAH rule offered 100% sensitivity but 31.6% specificity. Applying the EMERALD SAH rule to patients positive for the Ottawa SAH rule led to 92.6% sensitivity and 48.0% specificity. As the NLR alone showed less efficacy with the area under curve of 0.696 by receiver operating analysis, NLR (>2.1) was added to the last step to have achieve 99.0% sensitivity and 56.7% specificity.
The stepwise application of the Ottawa, EMERALD SAH rule, and NLR increased the specificity compared to each application. On the other hand, further studies will be needed to increase the sensitivity.
Key words: Subarachnoid hemorrhage; Headache; Differential diagnosis
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