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203, 639, 656, 672, 678, 692, 726, 1520, 1596, 1654], 'choice': [190], 'noncontrast': [193, 1416], 'CT': [194, 199, 227, 251, 257, 279, 307, 337, 411, 549, 829, 981, 1020, 1098, 1113, 1121, 1289, 1307, 1524, 2018], 'scan': [195, 338, 1290, 1308, 2019], 'brain.Although': [198], 'an': [201, 423, 780, 1035, 1124, 1300, 1330], 'excellent': [202], 'its': [206, 465], 'sensitivity': [207, 228, 308, 667, 1574], 'both': [209, 960, 1246, 1337], 'function': [211], 'timing': [213, 317], 'from': [214, 301, 355, 464, 964, 1041, 1462], 'as': [220, 222, 720, 984, 992, 1172, 1251, 1253, 1329], 'well': [221, 694, 1252], 'severity': [223, 650, 737, 843], 'hemorrhage.1': [226], 'extremely': [230], 'high': [231], 'early': [232, 1580], 'but': [233, 699], 'rapidly': [234], 'diminishes': [235], 'time.': [237], 'Clinicians': [238], 'frequently': [239], 'encounter': [240], 'normal': [242, 2017], 'negative': [250, 282, 410, 985, 1029, 1119, 1155, 2078], 'scan.': [252], 'Even': [253], 'using': [254], 'third-generation': [255], 'scanners,': [256], 'itself': [259], 'insufficient': [261], 'exclude': [263, 1303], 'SAH.2': [264], 'guidelines': [266], 'recommend': [267, 360], 'that': [268, 336, 384, 459, 475, 523, 546, 548, 654, 665, 745, 755, 764, 951, 1073, 1088, 1111, 1136, 1275], 'lumbar': [270, 1726, 2065], 'puncture': [271, 2066], '(LP)': [272], 'be': [273, 816, 908, 1115, 1224], 'performed': [274, 345, 554, 1116, 1680], 'these': [276, 610, 805, 905, 927, 1324], 'whose': [278, 513, 618], 'scans': [280, 970, 982], 'or': [283, 587, 777, 1354, 1556], 'nondiagnostic.3,4': [284], 'Although': [285, 633], 'LP': [286, 1026, 1036, 1125, 1301], 'relatively': [289], 'test,': [291], 'it': [292, 1169, 1177, 1217], 'adds': [293], 'time,': [294, 746], 'patient': [295, 403], 'discomfort,': [296], 'and,': [297], 'sometimes,': [298], 'ambiguity': [300], 'traumatic': [303], 'tap.Prior': [304], 'studies': [305, 611, 1162], 'do': [309], 'not': [310, 1022, 1038, 1079, 1179, 1183, 1194, 1235, 1348], 'adequately': [311], 'account': [312], 'issue': [315, 327], 'earliest': [320], 'hours': [321, 348, 919, 957, 1228, 1293, 1683], 'after': [322, 1027, 1117, 1715, 1925, 2076], 'hemorrhage.': [324, 1427, 1531, 1584], 'In': [325, 709, 997], 'Stroke,': [329], 'Backes': [330, 578, 634, 1508], 'et': [331, 865, 1447, 1548, 1674], 'al5': [332], 'data': [334, 368], 'suggesting': [335, 754, 1269], '100%': [340, 551], 'sensitive': [341, 552], 'SAH': [343, 414, 433, 479, 498, 514, 594, 621, 792, 847, 941, 1206, 1304], 'if': [344, 553, 601, 1196, 1305], 'within': [346, 487, 555, 917, 1226, 1291, 1681, 2020], '6': [347, 488, 625, 918, 1227, 1292, 2021, 2170], 'apart': [354], '2': [356, 536, 936], 'caveats,': [357], 'authors': [359], 'change': [362, 821], 'guidelines.': [365], 'Are': [366], 'their': [367, 526, 530], 'strong': [369], 'enough': [370], 'warrant': [372], 'such': [373], 'change?First': [375], 'let': [376], 'us': [377], 'consider': [378], 'caveats.': [380], 'first': [382, 540, 606], '<6-hour': [386], 'rule': [387, 2023], 'applies': [389, 1219], 'headache.': [394, 923, 1501, 1558], 'This': [395, 421, 490, 1009, 1244], 'because': [397, 426, 1048], 'they': [398, 510, 602, 655, 1074], 'identified': [399], 'single': [401], 'early-presenting': [402, 796, 928], 'acute': [405, 1500], 'neck': [406, 1242], 'pain': [407], 'who': [412, 954, 1033, 1043, 1222, 1282, 1321], 'had': [413, 891, 1078], 'due': [415], 'cervical': [418], 'arteriovenous': [419], 'malformation.': [420], 'important': [424, 1173], 'caveat': [425, 441], 'up': [427], 'without': [436, 1557], 'headache.6': [438], 'second': [440], 'study': [444, 473, 582, 597, 697, 853, 870, 974], 'setting;': [445], 'experienced': [446, 1016], 'neuroradiologists': [447, 963], 'at': [448, 517], 'referral': [450, 569, 616], 'center': [451], 'interpreted': [452, 968], 'scans.Are': [454], 'there': [455, 685], 'any': [456, 1167], 'other': [457, 537, 707, 935, 1153, 1203], 'limitations': [458], 'we': [460, 1273], 'must': [461, 1314], 'consider?': [462], 'Aside': [463], 'retrospective': [466, 613], 'design,': [467], 'one': [468], 'limitation': [469], 'Dutch': [472, 812], 'incidence': [477, 496, 592, 619, 648], 'was': [480, 515, 550, 567, 598, 948, 1004], '42%': [481], '(50%': [482], 'hours).': [489], 'far': [492, 1094], 'higher': [493, 778, 794], 'than': [494, 798], 'seen': [504], 'routine': [506], 'practice.1': [507], 'As': [508, 1046], 'well,': [509, 1047], 'excluded': [511], 'confirmed': [516], 'transferring': [519], 'hospital,': [520], 'another': [521], 'factor': [522], 'could': [524], 'skew': [525], 'results.': [527], 'That': [528], 'said,': [529], 'principal': [531], 'findings': [532], 'compatible': [534], 'relevant': [538], 'studies.The': [539], '2010': [543], 'Danish': [544, 581, 814], 'report': [545, 862], 'concluded': [547], '3': [556, 977], 'days': [557], 'headache.7': [560], 'Similar': [561], 'current': [564, 823], 'report,': [565], 'population': [570, 698, 742, 834, 900], 'neurosurgical': [573], 'center;': [574], 'however,': [575], 'unlike': [576], 'study,': [579], 'included': [583], 'focal': [586], 'generalized': [588], 'neurological': [589, 1189], 'deficits.': [590], '59%': [599], '(67%': [600], 'presented': [603, 955], '24': [607], 'hours).Both': [608], 'reports': [614, 815], 'populations': [617, 770], '5': [623], 'times': [626], 'what': [627], 'reported': [629], 'literature.': [632], 'colleagues': [636], 'state': [637], 'otherwise,': [638], 'performance': [640, 722], 'characteristics': [641, 675, 1521, 1551], 'part': [644], 'disease': [653, 682, 736, 776], 'given': [660, 804], 'population.Classic': [661], 'statistical': [662], 'theory': [663], 'teaches': [664], 'specificity': [669], 'fundamental': [674], 'independent': [680], 'prevalence.': [683], 'However,': [684], 'numerous': [687], 'examples': [688], 'performing': [693], 'failing': [700], 'yield': [702], 'same': [704], 'results': [705, 906], 'populations.8': [708], '1978,': [710], 'Rasenhoff': [711], 'Feinstein9': [713], 'described': [714], 'phenomenon': [716], 'spectrum': [718, 756, 808, 1618], 'bias': [719, 757, 1620], 'varying': [727], 'according': [728], 'case': [731], 'mix': [732], '(a': [733], 'combination': [734], 'prevalence)': [739], 'tested.': [743], 'Since': [744], 'growing': [748], 'body': [749], 'literature': [751], 'has': [752, 1100, 1151, 1327], 'emerged': [753], 'common,': [759], 'leading': [760], 'concept': [763], 'tests': [766], 'perform': [767], 'better': [768], 'prevalence.10As': [779], 'example': [781], 'relationship': [784], 'between': [785], 'prevalence': [786, 790, 845, 939], 'sensitivity,': [788], 'later.5,7': [802], 'So': [803], 'issues': [806, 1485], 'bias,': [809], 'can': [810, 1223], 'used': [817, 831], 'support': [819], 'guidelines?': [824], 'What': [825, 1702], 'happen': [827], 'when': [828, 1176], 'reflective': [836], 'real-world': [838], 'practice': [839, 1276], 'which': [841, 904, 980], 'much': [849, 895], 'lower?Fortunately,': [850], 'third': [852], 'helps': [854], 'resolve': [856], 'conundrum.': [858], '2011': [860], 'Canadian': [861, 883, 973, 1161], 'Perry': [864, 1661, 1848, 2043], 'al11': [866], 'prospective': [869, 1693], '3132': [872, 912], '11': [881], 'different': [882], 'emergency': [884, 987, 1254, 1394, 1422, 1497, 1858, 2057], 'departments.': [885], 'Two': [886], 'hundred': [887], 'forty': [888], '(7.7%)': [890], 'number': [894], 'representative': [897], 'applied.': [909], 'patients,': [913], '953': [914], 'were': [915, 930, 976, 989, 1057, 1069, 1075], 'scanned': [916, 1225], 'All': [924], '121': [925], 'CT-positive.': [931], 'Like': [932], 'studies,': [937], 'earlier': [944], 'group': [946], '(12.7%)': [947], 'over': [949], 'twice': [950], '>6': [956], '(5.5%).Numerous': [958], 'radiologists,': [959], 'general': [961], 'across': [965], 'multiple': [966], 'institutions,': [967], 'There': [975], 'instances': [978], 'read': [983, 991], 'physicians': [988, 1017], 'later': [990], 'positive': [993], 'radiologist.': [996], 'fourth': [999], 'instance,': [1000], 'false-negative': [1002], 'reading': [1003], 'radiology': [1007], 'trainee.': [1008], 'underscores': [1010], 'importance': [1012], 'having': [1014, 2063], 'well-trained,': [1015], 'interpret': [1018], 'scans.Although': [1021], 'all': [1023], 'underwent': [1025], 'CT,': [1030], 'received': [1034], 'did': [1037, 1044], 'differ': [1039], 'substantially': [1040], 'not.': [1045], 'healthcare': [1051, 1061, 1460], 'system': [1052], 'Canada,': [1054], 'researchers': [1056], 'able': [1058, 1070], 'obtain': [1060], 'follow-up': [1062], 'on': [1063, 1259], '>97%': [1064], 'show': [1072], 'alive': [1076], 'been': [1080], 'subsequently': [1081], 'diagnosed': [1082], 'SAH.': [1085, 1133], 'We': [1086, 1134], 'believe': [1087, 1135, 1274], 'strengths': [1090], 'article': [1093, 1346], 'outweigh': [1095], 'weaknesses.As': [1097], 'technology': [1099], 'become': [1101], 'increasingly': [1102], 'accurate': [1103], 'available,': [1105], 'some': [1106], 'begun': [1108], 'suggest': [1110, 1202], 'cerebral': [1112], 'angiography': [1114, 1722], 'instead': [1122], 'work-up': [1128], 'possible': [1132], '“technology': [1138], 'creep”': [1139], 'leads': [1141], 'asymptomatic': [1145], 'aneurysms': [1146], '(not': [1147], 'hemorrhage)': [1149], 'many': [1152], 'unintended': [1154, 1705], 'consequences.12': [1156], 'Dutch,': [1158], 'Danish,': [1159], 'reinforce': [1163], 'notion.Like': [1165], 'guideline,': [1168], 'just': [1171], 'know': [1175], 'does': [1178, 1182, 1193, 1234, 2015], 'apply.': [1180], 'It': [1181, 1191], 'apply': [1184, 1195, 1236], 'abnormal': [1188], 'examinations.': [1190], 'also': [1192], 'diagnoses': [1204], '(cerebral': [1207], 'venous': [1208], 'sinus': [1209], 'thrombosis,': [1210], 'arterial': [1211], 'dissections,': [1212], 'cerebellar': [1213], 'infarction,': [1214], 'etc).': [1215], 'Lastly,': [1216], 'specifically': [1233], 'isolated': [1241], 'pain.': [1243], 'reinforces': [1245], 'public': [1248], 'health': [1249], 'mandate': [1250], 'department': [1255, 1423, 1498, 1859], 'operations': [1256], 'focus': [1258], 'rapid': [1261], 'recognition': [1262], 'evaluation': [1264, 1488], 'symptoms': [1268], 'stroke.Given': [1270], 'analysis,': [1272], 'should': [1277], 'change.': [1278], 'Neurologically': [1279], 'undergo': [1288], 'symptom': [1295], 'no': [1297], 'longer': [1298], 'need': [1299], 'negative.': [1310], 'Physicians': [1311], 'hospitals': [1313], 'ensure': [1315], 'expertise': [1317], 'individuals': [1320], 'interpreting': [1323], 'scans.DisclosuresDr': [1325], 'served': [1328], 'expert': [1331], 'witness': [1332], 'medico-legal': [1334], 'cases': [1335], 'defense': [1338], 'plaintiff': [1340], 'firms.FootnotesThe': [1341], 'opinions': [1342], 'expressed': [1343], 'necessarily': [1349], 'editors': [1353], 'American': [1357, 1464, 2200], 'Heart': [1358, 1465, 2201], 'Association.Correspondence': [1359], 'One': [1365], 'Place,': [1367], 'Medicine': [1369, 1866, 2030], 'Administrative': [1370], 'Offices,': [1371], 'West': [1372], 'Clinical': [1373, 1482, 1550, 1775, 2059, 2081, 2157], '2nd': [1375], 'Floor,': [1376], 'MA': [1378], '02115.': [1379], 'E-mail': [1380], '[email': [1381], 'protected]harvard.eduReferences1.': [1382], 'JA,': [1384, 1473], 'Malek': [1385], 'AM,': [1386], 'Ogilvy': [1387], 'CS.': [1388], 'Aneurysmal': [1389, 1748, 1994], 'hemorrhage:': [1391, 1456], 'update': [1392], 'physicians.': [1395], 'J': [1396, 1559, 1606, 1630, 1765, 1796, 1849], 'Emerg': [1397, 1429, 1503, 1728], 'Med.': [1398, 1430, 1504, 1631, 1657, 1729], '2008;': [1399, 1431, 1505, 1563], '34:237–251.CrossrefMedlineGoogle': [1400], 'Scholar2.': [1401], 'Byyny': [1402], 'RL,': [1403], 'Mower': [1404], 'WR,': [1405], 'Shum': [1406], 'N,': [1407], 'Gabayan': [1408], 'GZ,': [1409], 'Fang': [1410], 'S,': [1411, 1538, 1567], 'Baraff': [1412], 'LJ.': [1413], 'Sensitivity': [1414, 1676, 2107], 'cranial': [1417], 'computed': [1418, 1576, 1678, 1717, 1720, 1855, 2079], 'tomography': [1419, 1577, 1679, 1718, 1856], 'Ann': [1428, 1502], '51:697–703.CrossrefMedlineGoogle': [1432], 'Scholar3.': [1433], 'Connolly': [1434], 'ES,': [1435], 'Rabinstein': [1436], 'AA,': [1437], 'Carhuapoma': [1438], 'JR,': [1439], 'Derdeyn': [1440], 'CP,': [1441], 'Dion': [1442], 'J,': [1443, 1792, 1830, 1836, 1904, 2044], 'Higashida': [1444], 'RT': [1445], ',': [1446, 1547, 1673], 'al.': [1448, 1549, 1675], 'Guidelines': [1449], 'management': [1452, 1490], 'guideline': [1458], 'professionals': [1461], 'Association/American': [1466], 'Stroke': [1467, 1560], 'Association.': [1468], 'Stroke.2012;': [1469, 1532], '43:1711–1737.LinkGoogle': [1470], 'Scholar4.': [1471], 'Panagos': [1474], 'PD,': [1475], 'Godwin': [1476], 'SA,': [1477], 'Thomas': [1478], 'TL,': [1479], 'Decker': [1480], 'WW.': [1481], 'policy:': [1483], 'critical': [1484], 'adult': [1492], '52:407–436.CrossrefMedlineGoogle': [1506], 'Scholar5.': [1507], 'D,': [1509, 1741, 1970, 1972, 1976, 1980], 'Rinkel': [1510, 2154], 'GJ,': [1511], 'Kemperman': [1512], 'H,': [1513, 1842, 1898, 1902], 'Linn': [1514], 'FH,': [1515], 'Vergouwen': [1516, 2151], 'M.': [1517], 'Time': [1518], 'dependent': [1519], 'head': [1523], 'suspected': [1527, 1862], 'non-traumatic': [1529], '43:2115–2119.LinkGoogle': [1533], 'Scholar6.': [1534], 'Naganuma': [1535], 'M,': [1536, 1670, 1786, 1822, 1824, 1826, 1828, 1838, 1840, 1978], 'Fujioka': [1537], 'Inatomi': [1539], 'Y,': [1540, 1544], 'Yonehara': [1541], 'T,': [1542, 1794], 'Hashimoto': [1543], 'Hirano': [1545], 'T': [1546, 1746], 'Cerebrovasc': [1561], 'Dis.': [1562], '17:334–339.CrossrefMedlineGoogle': [1564], 'Scholar7.': [1565], 'Cortnum': [1566], 'Sorensen': [1568], 'P,': [1569, 1974], 'Jorgensen': [1570], 'J.': [1571], 'Determining': [1572], 'scanning': [1578], 'detection': [1581], 'Neurosurgery.': [1585], '2010;': [1586, 1730], '66:900–902.MedlineGoogle': [1587], 'Scholar8.': [1588], 'Leeflang': [1589], 'MM,': [1590], 'Bossuyt': [1591], 'PM,': [1592], 'Irwig': [1593], 'L.': [1594], 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