Isolated headache in general practice: Determinants for delay in referral in patients with subarachnoid haemorrhage

Abstract

Background: A delay in diagnosing aneurismal subarachnoid haemorrhage (SAH) occurs in a substantial proportion of patients who present with headache as the only symptom. Objective: To identify determinants for a delay in referral in patients with SAH, who present with isolated headache to the general practitioner (GP). Methods: For all 112 patients with SAH admitted to the hospital between October 2008 and June 2009, we sent a questionnaire to the GPs asking for details presented during the initial GP visit. In this retrospective study, we included 31 patients with SAH who initially presented with isolated headache. We assessed acuteness of headache onset, history of headaches and a patient delay as determinants for delayed referral (> 2 h after a visit to the GP), by calculating risk ratios (RRs) with corresponding 95% confidence intervals (CIs). Results: Referral was delayed in 18 of these 31 patients. The delay occurred in all 10 patients in whom the GP was unaware of the acute onset of headache and in 8 of 21 patients in whom the GP was aware of this symptom (RR: 2.6; 95% CI: 1.5–4.5). A history of headaches (RR: 1.8; 95% CI: 1.1–3.0) and a patient delay (RR: 2.1; 95% CI: 1.0–4.5) also increased the probability of delayed referral.

Conclusion: In patients with SAH who presented with isolated headache to the GP, GP's unawareness of the acute onset of the headache, a history of headaches and late presentation by the patient increased the probability of delayed referral.

Key words::

• Subarachnoid haemorrhage
• aneurysm
• headache
• general practice

Acknowledgements

The authors should like to thank all the participating general practitioners for their time and effort invested in this study. The authors also should like to thank Professor Algra for his help with the statistical analysis and Miss Collington and Mrs Wilson for their help in reviewing the text.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.