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Home > List Archives

C-spine clearance

trauma-list@trauma.org trauma-list@trauma.org
Fri, 25 Apr 2003 20:57:21 EDT


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In a message dated 4/25/2003 1:59:01 PM Eastern Daylight Time, 
karim@trauma.org writes:

> No one wants to miss an injury.  However the incidence of unstable,
> ligamentous or disc injury without CT evidence is very low.  Our previous
> protocol included MRI but proved to expensive - in terms of intensivist 
> time
> away from the unit and MRI time - and as such patients still were not being
> cleared until day 4,5,6,7...  Our Trauma Committee concluded that the
> detrimental effects on the majority of patients of prolonged spinal
> immobilisation outweighed the potential possibility of missing an
> undisplaced, unstable ligamentous injury.
> 
> Individual institutions must decide what level of risk they are prepared to
> accept, and at what cost, given that no test is ever 100%.
> 
> 

Karim--
I actually fully agree with your reasoning here--the cost:benefit ratio of 
going to the lengths some demand for a truly infinitesimal risk of a 
clinically adverse result (or even of an irrelevant radiologically adverse 
result)  I hope your data can help us become more reasonable in our approach 
to this issue--generally these protocols are driven more by hospital lawyers 
and administrators who have no earthly concept of the meaning of risk or of 
any aspect of the practice of medicine.
ERF

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">In a message dated 4/25/2003 1:59:01 PM Eastern Daylig=
ht Time, karim@trauma.org writes:<BR>
<BR>
<BLOCKQUOTE TYPE=3DCITE style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT=
: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">No one wants to miss an injury.=
&nbsp; However the incidence of unstable,<BR>
ligamentous or disc injury without CT evidence is very low.&nbsp; Our previo=
us<BR>
protocol included MRI but proved to expensive - in terms of intensivist time=
<BR>
away from the unit and MRI time - and as such patients still were not being<=
BR>
cleared until day 4,5,6,7...&nbsp; Our Trauma Committee concluded that the<B=
R>
detrimental effects on the majority of patients of prolonged spinal<BR>
immobilisation outweighed the potential possibility of missing an<BR>
undisplaced, unstable ligamentous injury.<BR>
<BR>
Individual institutions must decide what level of risk they are prepared to<=
BR>
accept, and at what cost, given that no test is ever 100%.<BR>
<BR>
</BLOCKQUOTE><BR>
<BR>
Karim--<BR>
I actually fully agree with your reasoning here--the cost:benefit ratio of g=
oing to the lengths some demand for a truly infinitesimal risk of a clinical=
ly adverse result (or even of an irrelevant radiologically adverse result)&n=
bsp; I hope your data can help us become more reasonable in our approach to=20=
this issue--generally these protocols are driven more by hospital lawyers an=
d administrators who have no earthly concept of the meaning of risk or of an=
y aspect of the practice of medicine.<BR>
ERF</FONT></HTML>

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