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Sun, 17 Mar 2002 13:45:55 EST

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In a message dated 3/17/2002 12:36:14 PM Eastern Standard Time, 
karim@trauma.org writes:

> I only consider potentially using CT in the unconscious patient because 
> clinical examination is compromised (neuro exam, odynophagia, dysphonia 
> etc).  I'm not sure about the feasibility/accurracy of contrast swallow in 
> the unconscious patient - especially for high oesophageal/pharyngeal 
> injuries.  Oesphagoscopy is reported as only 90% sensitive - and some 
> studies recommend both scope & contrast swallow to exclude injury.
>  
> 

Your last statement is correct, as this combination approaches 100% 
reliability for esphageal injury--and can be easily applied in the 
unconscious patient.  CT scan has no known accuracy whatever in picking up 
esophageal injuries (its value for vascular and airway injuries is only in 
its infancy of proof), so I am not sure how you even conjecture its role in 
this setting. Only 7% of all penetrating neck injuries injure the esophagus. 
Arteriography is similarly applicable in the unconscious patient for vascular 
injury, which occurs in less than 50% of all penetrating neck trauma---and 
both are far more well studied and validated than neck CT.    How easy 
something is for the physician, and how nice its pictures are, have no 
relation to its validity.  I continue to be amazed at how readily some are 
willing to accept completely unproven but "chic" modalities (i.e. CT, MRI, 
etc) while demanding the nth degree of scientific proof of others which, I 
guess, are just too easy and non-hi-tech to be attractive (i.e. phys exam 
alone, even after such data is extensively published).  This of course does 
not apply to you, Karim, but to your radiologists. There is clear hypocrisy 
in this observation. 
ERF

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<HTML>In a message dated 3/17/2002 12:36:14 PM Eastern Standard Time, karim@trauma.org writes: 
 
 
<BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">I only consider potentially using CT in the unconscious patient because clinical examination is compromised (neuro exam, odynophagia, dysphonia etc).&nbsp; I'm not sure about the feasibility/accurracy of contrast swallow in the unconscious patient - especially for high oesophageal/pharyngeal injuries.&nbsp; Oesphagoscopy is reported as only 90% sensitive - and some studies recommend both scope &amp; contrast swallow to exclude injury. 
 
</BLOCKQUOTE> 
 
Your last statement is correct, as this combination approaches 100% reliability for esphageal injury--and can be easily applied in the unconscious patient.&nbsp; CT scan has no known accuracy whatever in picking up esophageal injuries (its value for vascular and airway injuries is only in its infancy of proof), so I am not sure how you even conjecture its role in this setting. Only 7% of all penetrating neck injuries injure the esophagus. Arteriography is similarly applicable in the unconscious patient for vascular injury, which occurs in less than 50% of all penetrating neck trauma---and both are far more well studied and validated than neck CT.&nbsp;&nbsp;&nbsp; How easy something is for the physician, and how nice its pictures are, have no relation to its validity.&nbsp; I continue to be amazed at how readily some are willing to accept completely unproven but "chic" modalities (i.e. CT, MRI, etc) while demanding the nth degree of scientific proof of others which, I guess, are just too easy and non-hi-tech to be attractive (i.e. phys exam alone, even after such data is extensively published).&nbsp; This of course does not apply to you, Karim, but to your radiologists. There is clear hypocrisy in this observation. 
ERF</HTML>

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