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Subarachnoid haemorrhage: the canary in the mine, or the elephant in the room?
  1. David Nicholl1,
  2. Stuart Weatherby2
  1. 1Neurology Department, Birmingham City Hospital, Birmingham, West Midlands, UK
  2. 2Neurology Department, Derriford Hospital, Plymouth, Devon, UK
  1. Correspondence to Dr David Nicholl, Neurology Department, Birmingham City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK; david.nicholl{at}

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The recent UK national confidential enquiry into patient outcome and death (NCEPOD) from subarachnoid haemorrhage (SAH) identified a number of issues pertinent to the early diagnosis and investigation of patients presenting with acute headache.1 The NCEPOD investigators should be congratulated on this excellent nationwide survey. Their efforts will not only improve the care of patients with SAH but also those with other acute headache disorders.

There is evidence of widespread good practice, with prompt diagnosis and treatment for many patients. However, as in many such surveys, it is often the gaps and failings that are most revealing. For example,

  • 32% of secondary care hospitals had no protocol or policy to investigate and treat acute onset headache.

  • 43% (32 of 75) of patients in primary care had their diagnosis of aneurysmal subarachnoid haemorrhage overlooked, a delay that may have affected the outcome in 72% (23/32).

  • 13% (49 of 383) …

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  • Contributors SW wrote the initial draft and DN redrafted it. Both authors agreed on the submitted version.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Ed Dunn, Leeds.

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