What is the clinical impact of the Ottawa subarachnoid hemorrhage rule and the 6-hour-computed tomography rule on investigation rates?

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Why is this study important?

Subarachnoid hemorrhage (SAH) represents approximately 1% of all headaches seen in the emergency department (ED).[1] Given the severe consequences of a missed diagnosis, patients with suspected SAH often undergo invasive tests such as lumbar puncture (LP) or computed tomography angiography (CTA). These investigations increase patient risk as well as healthcare costs and delays to ED discharge. This study assesses the impact of the combined Ottawa SAH and the 6-Hour-Computed Tomography (CT) rules on reducing investigations in those headache patients at low risk of SAH.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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