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Sat, 26 Apr 2003 13:33:46 -0500

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I would add that sagittal reconstructions are very helpful.  Plain films
of the c-spine are .retardedly difficult to interpret.  There are so
many shadows that overlap and criss-cross.  Line-up these lines on this
view, then look at the Scotty dog on this view, the odontoid has .. It
is near impossible to truly feel comfortable about c-spine plain films.

E

Errington C. Thompson, MD
Trauma Surgeon
Trinity Mother Frances
Tyler, Tx
ecthompson@tyler.net

Don't think you are
Know you are
                            - Morpheus (The Matrix)

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of DocRickFry@aol.com
Sent: Saturday, April 26, 2003 7:59 AM
To: trauma-list@trauma.org
Subject: Re: C-spine clearance

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
www.east.org.  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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<div class=3DSection1>

I would add that sagittal reconstructions are very =
helpful.&nbsp; Plain films of the c-spine
are &#8230;retardedly difficult to interpret.&nbsp; There are so many shadows that =
overlap
and criss-cross. &nbsp;Line-up =
these
lines on this view, then look at the Scotty dog on this view, the =
odontoid has &#8230;.
It is near impossible to truly feel comfortable about c-spine
plain films.&nbsp; =
<o:p></o:p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'>E<o:p></=
o:p></span></font></p>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;mso-bidi-font-family:Arial;color:navy'><o:p>&nb=
sp;</o:p></span></font></p>

<div>

<p class=3DMsoAutoSig><st1:PersonName><font size=3D3 color=3Dnavy
 face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy;mso-no-proof:
 yes'>Errington</span></font></st1:PersonName><font color=3Dnavy><span
style=3D'color:navy;mso-no-proof:yes'> C. Thompson, =
MD<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Trauma =
Surgeon<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Trinity Mother =
Frances<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Tyler, =
Tx<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><st1:PersonName><font size=3D3 color=3Dnavy
 face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy;mso-no-proof:
 yes'>ecthompson</span></font></st1:PersonName><font color=3Dnavy><span
style=3D'color:navy;mso-no-proof:yes'>@tyler.net<o:p></o:p></span></font>=
</p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'><o:p>&nbsp;</o:p><=
/span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Don't think you =
are<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'>Know you =
are<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:navy;mso-no-proof:yes'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>- Morpheus (The Matrix)<o:p></o:p></span></font></p>

</div>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
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sp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'>-----Original =
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> =
trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org] <b><span =
style=3D'font-weight:bold'>On
Behalf Of </span></b>DocRickFry@aol.com<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Saturday, April 26, =
2003
7:59 AM<br>
<b><span style=3D'font-weight:bold'>To:</span></b> =
trauma-list@trauma.org<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> Re: C-spine =
clearance</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DArial><span
style=3D'font-size:10.0pt;font-family:Arial'>In a message dated =
4/26/2003 6:18:34
AM Eastern Daylight Time, jrmk@mweb.co.za writes:<br>
<br style=3D'mso-special-character:line-break'>
<![if !supportLineBreakNewLine]><br =
style=3D'mso-special-character:line-break'>
<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal =
style=3D'mso-margin-top-alt:0in;margin-right:0in;margin-bottom:
12.0pt;margin-left:.5in'><font size=3D2 face=3DArial><span =
style=3D'font-size:10.0pt;
font-family:Arial'>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.<o:p></o:p></span></font></p>

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.&nbsp; 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.&nbsp; 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/3D"www.east.org">www.east.org</a>.&nbsp;
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<o:p></o:p>

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