Diagnosis of Subarachnoid Hemorrhage – Time for a Paradigm Shift?

Abstract

The second edition of Thomas Kuhn's "Structure of Scientific Revolutions" that captivated one of us in college was published in 1970.¹ In the book, Kuhn argues that progress in science is made not by the step-by-step building of incremental ideas or experiments, but by paradigm shifts – whole new ways of looking at phenomena using novel tools (the telescope for Galileo) or concepts (a heliotropic, rather than a geotropic solar system for Copernicus). Our current paradigm about misdiagnosis of patients with aneurysmal subarachnoid hemorrhage (SAH) is that patients who were misdiagnosed on a first visit to a physician who are then correctly diagnosed on a subsequent visit have worse outcomes than patients who are correctly diagnosed in the first place. Now, new data challenge this time-honored concept.

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