Should Bilirubin Testing be Performed Out-of-Hours?
About 95-98% of patients presenting to hospital with Subarachnoid Haemorrhage will have blood detected on CT Brain, if scanned within 24 hours of first onset of headache. Patients with suspected subarachnoid haemorrhage, who have normal CT Brain, do not need to have their CSF spectrophotometry analysed and interpreted out-of-hours. The lumbar puncture procedure does not need to wait till the next morning, but the CSF test result is not urgent. CSF analysis can wait until the following morning, as immediate knowledge of a positive CSF is unlikely to alter overnight management. For example, if a CT negative patient deteriorates overnight, they may need a repeat CT Brain irrespective of the CSF result (for example to detect a fresh bleed or hydrocephalus).
