To the Editor In their recent study, Dr Perry and colleagues1 addressed the challenging problem of misdiagnosis of subarachnoid hemorrhage. Perry et al1 reported 100% sensitivity for detecting subarachnoid hemorrhage, using the new Ottawa subarachnoid hemorrhage rule (OSHR). Despite this finding, 3 of the 6 characteristics in the rule showed only modest reliability (κ<0.60) among physicians. Limited flexion, thunderclap headache, and neck pain and stiffness were prevalent in subarachnoid hemorrhage, and the OSHR required that only 1 needed to be present for further investigation to be warranted.
Specogna AV. Subarachnoid Hemorrhage Diagnosis. JAMA. 2014;311(2):201. doi:10.1001/jama.2013.284318