Spinal tap following a negative CT in suspected SAH

Do we still need spinal tap following a negative CT in worst headache of life?

It’s deeply rooted medical dogma that spinal tap needs to follow a negative CT when evaluating patients for subarachnoid hemorrhage. New literature has come out to challenge that idea.

We talk with Scott Weingart of emcrit.org and Ryan Radecki of Emergency Medicine Literature of Note about a 2011 BMJ paper that looks at the sensitivity of computed tomography when performed within 6 hours of headache onset.

Keeping with the neurology theme, what’s the story with awake blunt trauma patients with a negative cervical spine CT who still have neck pain…do they need an MRI?


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  1. Pbjpaulito

    Great podcast folks really enjoyed the discussion about importance of imaging for c-spine. Very relevant after just finishing ATLS. Was asked repeatedly to read plain films of c-spine. Also definitely been doing LPs on patients with normal CTs so I’ll have to chat with my attendings to see what they make of this new perspective on its utility.

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  2. Casey

    Hi Rob. Nice discussion. Thanks for your interest in the Broome Docs blog.

    Is anyone in the big centers doing plain film Cspine imaging in trauma? I sometimes feel guilty for doing CTs on lower risk patients, but know they would likely get a CT in a trauma centre -so I do it anyway.
    Am I out of touch? Or do we just do too many CTs for lesser trauma patients? Casey

  3. Michael Jasumback


    Ought to include SMARTEM in this conversation. David Newman opened this up last December on SMARTEM and did the ultimate “Deep Dive” on the available literature at the time. Unfortunately it is going to take a while for this to make “Standard of Care”. Remember, we are often still told to give steroids for spinal cord injury! (not as often as we used to be though)

    Mike Jasumback

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  5. John Cronin (@croninjj)

    Hi Rob/Scott,
    Bit of an aside here, but Scott said 1 minute in, when you were talking about nice pens, that you don’t like giving patients the nice pen to sign their charts as they’re leaving………..Do you get patients to sign their charts as they’re leaving in the U.S.? Or is it just patients leaving against medical advice? which we would do here too. I assume its not every patient you see/treat….is it?


    1. Rob Orman

      In the EDs where I have worked, patients generally sign documents at registration and then sign a copy of their discharge instructions.

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