It'll never catch on. Generally speaking, if you can pronounce the 
initialism as a word (i.e. a true acronym) then it's best that that word has 
no other previously recognised meaning, e.g. NOF, TURP, URTI and NATO, SCUBA 
etc, or else has a meaning that is close to the topic in question e.g. SAD, 
PEG and BRITs, MACHOs, WIMPs etc. I figure no-one is going to pronounce LASH 
as L-A-S-H; they'll just say "lash", that is assuming it catches on.

There are very occasional medical exceptions to this, the most well known 
and the only two I can think of right now being CABG and AIDs, each 
pronounced as a word but unrelated to the topic in question. However, in 
each of these examples the acronym was coined very shortly after the 
condition or procedure arose. Headaches have been with us a long time now. 
In saying that, "lone acute severe" ("severe" surely fits better than 
"sudden" which is already covered by the word "acute", although some might 
argue that point) does neatly describe the particular patient population in 
question. But I still don't think it'll catch on...

AF


----- Original Message ----- 
From: "Andres" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 27, 2006 12:33 AM
Subject: Re: SAH


Lone acute sudden Headache (LASH).... I still prefer the term "my head 
hurts" at least I can understand it

Andres

-----Original Message-----
From: Accident and Emergency Academic List 
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 26 February 2006 23:38
To: [log in to unmask]
Subject: Re: SAH

Not at all, I've no idea. I figure it must be Leicester slang for something!

AF

----- Original Message ----- 
From: "Paul Middleton" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, February 26, 2006 11:18 PM
Subject: Re: SAH


I might be behind the times but what's LASH?

Paul


------ Original Message ------
Received: Mon, 27 Feb 2006 04:54:46 AM EST
From: Coats Tim - Professor of Emergency Medicine <[log in to unmask]>
To: [log in to unmask]
Subject: Re: SAH




Paul,

I don't think that we have the data to give absolute answers to the
interesting questions that you pose.

1) Role of LP when CT negative - depends on the pre-test probability of SAH.
About 5% of the scans that we do for LASH show SAH (so we know that
Emergency Physicians's threshold for CT scanning is about a 5% risk - you
can work out your own threshold by looking back at what proportion of the
scans you have recently ordered are positive). With this 5% pre-test
probability and a negative likelihood ratio of 0.02 for CT scanning the
post-test probability of SAH means that it is likely that about 1000 LPs
will need to be performed to find each CT negative SAH. (Assuming that CT is
as good a test in low probability patients as in high probability patients).
(Article with the details due to be published in the European Journal, March
edition). As CT scanning is a good test for SAH, we maybe should be talking
to our patients about their post test probability, their attitude to risk
and whether they wish to have any further investigations (LP is probably not
to be undergone lightly).

2) CT angio has limited resolution and is answering a different question
from a LP. If you want to know if there is an operable structural
abnormality  CT angio may provide the answer, however the question usually
is 'has the patient had an SAH'. If I was a patient I think that I would
want to know if I had suffered a SAH, even if no structural abnormality
could be found. (Maybe I would give up my hobby of bungee jumping and be
just that bit more appreciative of life!).

3) The influence of new generation CT scanners is interesting - you are
correct about technology running ahead of us. All of the published data (the
98% sensitivity etc) seems to be from more than 5 years ago - therefore
before the current generation of multi-slice scanners. How does this alter
the negative likelihood ratio? Not sure, but it probably makes a CT scan a
more sensitive test.

We risk stratify and accept 'low risk' rather than 'no risk' in many areas
of emergency care (a PE can be just as fatal as a SAH). It is therefore a
bit anomalous that we strive for 'no risk' in SAH.

My views on investigation of LASH come with a health warning - the dogma
that every patient who has a CT for LASH must have an LP is very well
entrenched. There is insufficient data to support any other approach, so
deviate from the current 'norm' at your medico-legal peril. However, I will
bet my hat that in 10 years time we will be risk stratifying and limiting
the number of LPs that we perform.

Tim

Tim Coats.
Professor of Emergency Medicine.
Leicester University.


  -----Original Message-----
  From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Paul Bailey
  Sent: 25 February 2006 03:44
  To: [log in to unmask]
  Subject: SAH


  I am beginning to wonder if I am still subscribed to the list as I
haven’t heard much from you all of late.



  I wanted to bring up the topic of subarachnoid haemorrhage.



  I find myself, as time goes on, becoming increasingly interested in
patient safety, uniformity in the delivery of emergency medicine (or
complete lack thereof), the concept of ‘risk assessment’ as the core of
our specialty, the concept of acceptable miss rates for particular
conditions, and finally the approach to low prevalence high mortality
conditions such as SAH.  In a lot of imaging related areas we have the
additional problem of the wavefront of imaging technology being
significantly ahead of the literature on most subjects – eg CTPA for PE
and the role / sensitivity / accuracy of multislice CT – creating an
evidence vacuum for a lot of the things that we do.



  With that out of the way I have been thinking a lot about SAH recently.



  In particular, two things:



  the role of LP when a high quality (ie no movement or artifact issues)
multislice CT is negative.



  Why we aren’t just doing CT angiograms on everyone (and perhaps
obviating the need for LP) given that this is what happens in a lot of
centres when xanthochromia is positive.



  Out of interest, I am sure it occurs, but no-one in my institution has
seen a 16 slice CT Head negative xanthochromia positive patient actually end
up having a procedure – ie the CT angiogram / MR angiogram is always
normal in this situation and no-one can really figure out where the blood
came from.



  So, I’m opening it up to the collective wisdom of acad-ae-med.  What are
all of your thoughts on the matter?

  Kind regards


  Paul Bailey

  Emergency Physician

  Western Australia






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