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Sat, 26 Apr 2003 08:58:50 EDT

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In a message dated 4/26/2003 6:18:34 AM Eastern Daylight Time, 
jrmk@mweb.co.za writes:

> 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.
> 
> 

Well, a few points:
First, IF you are going to use plain films as a screen, it is now well 
established that a lateral, or the two views you use, are worthless--do not 
at all accomplish what you want, i.e. screening for injury, because they can 
miss too many. You must at least do the standard three views--AP, lateral 
and odontoid.
Second--it is now becoming increasingly clear that CT of the full c-spine far 
and away finds many more injuries than does plain films, and several papers 
are now coming out all showing this. We used to have the same philosophy as 
your radiologists, but this should be reconsidered.
As a start if you want to acquaint yourself with the current literature and 
consensus, try the EAST Practice Management Guidelines at <A HREF=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"www.east.org">www.east.org</A>. Also 
on that website is a listing of the abstracts from the 2003 EAST meeting, 
where you will find 5 papers dealing with c-spine clearance that will be 
published later this year--all conclude the same thing regarding CT vs plain 
films
ERF

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<HTML>In a message dated 4/26/2003 6:18:34 AM Eastern Daylig=
ht Time, jrmk@mweb.co.za writes: 
 
<BLOCKQUOTE TYPE=3DCITE style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT=
: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">What I do want to as ask is whe=
ther their statement that they refuse full neck CT, due to the amount of rad=
iation involved.&nbsp; They refuse to budge from the fact that they will onl=
y CT the areas which show abnormality on X-ray review (AP and lateral only a=
re taken) if unevaluable or in the case of a conscious patient, the areas of=
 tenderness +- AP lateral X-rays abnormalities. 
 
</BLOCKQUOTE> 
 
Well, a few points: 
First, IF you are going to use plain films as a screen, it is now well estab=
lished that a lateral, or the two views you use, are worthless--do not at al=
l accomplish what you want, i.e. screening for injury, because they can miss=
 too many.&nbsp; You must at least do the standard three views--AP, lateral=20=
and odontoid. 
Second--it is now becoming increasingly clear that CT of the full c-spine fa=
r and away finds many more injuries than does plain films, and several paper=
s are now coming out all showing this.&nbsp; We used to have the same philos=
ophy as your radiologists, but this should be reconsidered. 
As a start if you want to acquaint yourself with the current literature and=20=
consensus, try the EAST Practice Management Guidelines at <A HREF=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/3D"www.eas=
t.org">www.east.org</A>.&nbsp; Also on that website is a listing of the abst=
racts from the 2003 EAST meeting, where you will find 5 papers dealing with=20=
c-spine clearance that will be published later this year--all conclude the s=
ame thing regarding CT vs plain films 
ERF</HTML>

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C-spine clearance