You're forgiven. I suspected it arose from one of those randomised 
controlled trials: you know, the type cardiologists dream up amazing 
acronyms for. And it did sound faintly "apronymic" which I found intriguing, 
i.e. it sounds a bit like what it's describing but not quite. But maybe 
that's just my subconscious sadomasochistic fantasies coming to the surface!

AF

----- Original Message ----- 
From: "Coats Tim - Professor of Emergency Medicine" 
<[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, March 01, 2006 12:08 PM
Subject: Re: SAH


>I may just be adopting an americanism - however I do like a phrase that is 
>different from "headache" - which can of course cover a multitude of 
>problems. LASH (lone, acute, severe, headache) defines an important 
>subgroup (no neurology, sudden onset, very bad) I cannot think of an 
>alternative short and convenient way of describing this group.
> On reflection maybe we should just descibe each patient rather than force 
> them into categories and create more acronyms - but laziness will probably 
> get the better of me.
>
> Leicester slang can be recognised as it always starts with "oooya" - as in 
> "oooya beauty" when you stick a needle into someone.
>
> Tim.
>
>
> -----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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