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C-spine clearance

Dr Juan H Klopper trauma-list@trauma.org
Sat, 26 Apr 2003 11:43:10 +0200


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I only recently got to reading this thread and might have missed some 
salient points.  Although I don't work in our trauma unit, I do have to 
manage these while on-call for Surgery.  At this time our Radiology 
Department is exteremely low on staff, etc., etc..  

What I do want to as ask is whether their statement that they refuse 
full neck CT, due to the amount of radiation involved.  They refuse to 
budge from the fact that they will only CT the areas which show 
abnormality on X-ray review (AP and lateral only are taken) if 
unevaluable or in the case of a conscious patient, the areas of 
tenderness +- AP lateral X-rays abnormalities.

Please help us in getting into the 21st century.

Juan H Klopper.
Consultant Surgeon
Free State University.
South Africa.

DocRickFry@aol.com wrote:

> 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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I only recently got to reading this thread and might have missed some salient
points. &nbsp;Although I don't work in our trauma unit, I do have to manage these
while on-call for Surgery. &nbsp;At this time our Radiology Department is exteremely
low on staff, etc., etc.. &nbsp;<br>
<br>
What I do want to as ask is whether their statement that they refuse full
neck CT, due to the amount of radiation involved. &nbsp;They refuse to budge from
the fact that they will only CT the areas which show abnormality on X-ray
review (AP and lateral only are taken) if unevaluable or in the case of a
conscious patient, the areas of tenderness +- AP lateral X-rays abnormalities.<br>
<br>
Please help us in getting into the 21st century.<br>
<br>
Juan H Klopper.<br>
Consultant Surgeon<br>
Free State University.<br>
South Africa.<br>
<br>
<a class="moz-txt-link-abbreviated" href="mailto:DocRickFry@aol.com">DocRickFry@aol.com</a> wrote:<br>
<blockquote type="cite" cite="mid190.195f76a4.2bdb3371@aol.com"><font
 face="arial,helvetica"><font size="2" family="SANSSERIF" face="Arial"
 lang="0">In a message dated 4/25/2003 1:59:01 PM Eastern Daylight Time,
<a class="moz-txt-link-abbreviated" href="mailto:karim@trauma.org">karim@trauma.org</a> writes:<br>
 <br>
 
  <blockquote type="CITE"
 style="border-left: 2px solid rgb(0,0,255); 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 previous<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<br>
 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 going to the lengths some demand for a truly infinitesimal risk of a clinically
adverse result (or even of an irrelevant radiologically adverse result)&nbsp;
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.<br>
 ERF</font></font></blockquote>
<br>
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