Key Points
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NICE guideline 228 application for FHFT clinicians
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Make clear the steps to take if SAH confirmed on CT or LP
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Recognising the importance of clear history, examination findings and documentation
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To involve senior decision-makers to identify and manage SAH
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Abbreviations
Overview
Frimley Health NHS Foundation Trust accepts the recommendations of the NICE guideline 228 Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management.
The full guideline can be found at https://www.nice.org.uk/guidance/ng228
Neither Frimley Park Hospital nor Wexham Park Hospital are a neurosurgical centre and the application of NICE guideline 228 is reflected by a simplified imaging decision-making flow diagram (below). This is to emphasise that once SAH is confirmed on either CT head or by LP, further investigation and management take place in the tertiary neurosurgical centre at either St. George’s Hospital (FPH) or John Radcliffe Hospital (WPH). Urgent advice should be sought on the https://www.referapatient.org/ (FPH) or OARS (WPH) referral pathway for patients with confirmed SAH.
First diagnostic investigation: non contrast CT head (urgent)
Positive CT head result (blood in subarachnoid space)
Diagnose SAH
FPH – Complete Urgent referral to St George’s Hospital Neurosurgical Team
WPH – Complete Urgent OARs Referral to John Radcliffe Hospital Neurosurgical Team. Contact oncall Neurosurgical SpR
Negative CT head completed more than 6 hours after symptom onset
Refer to the acute medical team to consider lumbar puncture, done at least 12 hours after symptom onset
Negative CT head completed within 6 hours of symptom onset, and reported by a radiologist
Think about alternative diagnoses and seek senior EM advice
Reference
National Institute for Health and Care Excellence [NICE] (2022) Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management. NG228. Available at: https://www.nice.org.uk/guidance/ng228 (Accessed; 05 October 2023).
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This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.
This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.
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