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Wed, 20 Feb 2002 11:06:44 -0500

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Laurie,

Thanks very kindly--this is more than I expected.  Sadly, however, my quest
continues.

First and foremost, I'm suspicious at the assertion that AVPU is an ACS
invention.  I no longer possess a 1993 ATLS Manual (listed among the
references), but if anyone is able to relate to me where it states anything
like "the College has created the AVPU method as a useful alternative to the
Glasgow Coma Scale," I'd be eager to hear about it.

Also, the paper provides an unconvincing argument in favor of AVPU, at best
amplifying its poor sensitivity to describe or recommend much of anything.
Among the highlights of the discussion:  "Patients who are responsive only
to a painful stimulus will usually have a GCS of 8 or less and therefore may
be at risk of airway problems."   A curious conclusion, being that 46% of
these patients have a GCS of 9 or more...  Strange (perhaps telling) that
the investigators spent so much time collecting numbers, but never subjected
them to any real statistical analysis.

Finally, consider the objectives: to associate AVPU with GCS, presumably
because AVPU is easier, and GCS only works with trained practitioners;
however, within the conclusion and discussion, it is repeatedly suggested
that AVPU suffers from a lack of an objective assessment guideline, and
practitioners of AVPU are undertrained.  If you're going to go to all that
effort to improve upon a tool which is so clearly inferior to GCS, why not
simply improve the utilization of GCS?

On and on, round and round...

Pret

----Original Message-----
From: Laurie [mailto:ggh@bentonrea.com]
Sent: Tuesday, February 19, 2002 9:04 PM
To: trauma-list@trauma.org
Subject: Fw: ORIGINS OF APUV

Dear Pret,

Attached you will find the answer to your quest. 

Laurie Grimes
Research fiend

http://www.google.com/search?q=cache:KbAYukdct-oC:www.basics.freewire.co.uk/
Templates/DLMar00/9919.pdf+neurological+assessment+tool+%27APUV%22
<http://www.google.com/search?q=cache:KbAYukdct-oC:www.basics.freewire.co.uk
/Templates/DLMar00/9919.pdf+neurological+assessment+tool+%27APUV%22&hl=en>
&hl=en 

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<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002>Laurie,</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=980573612-20022002>Thanks 
very kindly--this is more than I expected.&nbsp; Sadly, however, my quest 
continues.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=980573612-20022002>First 
and foremost, I'm suspicious at the assertion that AVPU is an ACS 
invention.&nbsp; I no longer possess a 1993 ATLS Manual (listed among the 
references), but if anyone is able to relate to me where it states anything like 
"the College has created the AVPU method&nbsp;as a useful alternative to the 
Glasgow Coma Scale," I'd be eager to hear about it.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=980573612-20022002>Also, 
the paper provides an unconvincing argument in favor of AVPU, at best amplifying 
its poor sensitivity to describe or recommend much of anything.&nbsp; Among the 
highlights of the discussion:&nbsp; "<EM>Patients who are responsive only to a 
painful stimulus will usually have a GCS of 8 or less and therefore may be at 
risk of airway problems</EM>."&nbsp;&nbsp; A curious conclusion, being 
that&nbsp;46% of these patients have a GCS of 9 or more...&nbsp; Strange 
(perhaps telling) that the investigators spent so much time collecting numbers, 
but never subjected them to any real statistical analysis.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002>Finally, consider the objectives: to associate AVPU 
with GCS, presumably because AVPU is easier, and GCS only works with trained 
practitioners; however, within the conclusion&nbsp;and discussion, it is 
repeatedly suggested that AVPU suffers from a lack of an objective assessment 
guideline, and practitioners of AVPU are undertrained.&nbsp; If you're going to 
go to all that effort to improve upon a tool which is so clearly inferior to 
GCS, why not simply improve the utilization of GCS?</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=980573612-20022002>On and 
on, round and round...</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002>Pret</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=980573612-20022002></SPAN></FONT><FONT face=Tahoma 
size=2></FONT>&nbsp;</DIV>
<DIV><FONT face=Tahoma size=2>----Original Message-----<BR><B>From:</B> Laurie 
[mailto:ggh@bentonrea.com]<BR><B>Sent:</B> Tuesday, February 19, 2002 9:04 
PM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Fw: ORIGINS OF 
APUV<BR><BR></DIV>
<BLOCKQUOTE></FONT>
  <DIV>&nbsp;</DIV>
  <DIV><BR></DIV>
  <DIV>Dear Pret,</DIV>
  <DIV>&nbsp;</DIV>
  <DIV>Attached you will find the answer to your quest. </DIV>
  <DIV>&nbsp;</DIV>
  <DIV>Laurie Grimes</DIV>
  <DIV>Research fiend<BR></DIV>
  <DIV>&nbsp;</DIV><BR>&nbsp;<A 
  href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/"http://www.google.com/search?q=cache:KbAYukdct-oC:www.basics.freewire.co.uk/Templates/DLMar00/9919.pdf+neurological+assessment+tool+%27APUV%22&amp;hl=en">http://www.google.com/search?q=cache:KbAYukdct-oC:www.basics.freewire.co.uk/Templates/DLMar00/9919.pdf+neurological+assessment+tool+%27APUV%22&amp;hl=en</A> 
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