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Fri Feb 18 10:12:43 GMT 2005

Dear dr frykberg,

why are you so sensitive about semantics? There is quite a difference in the populations we serve, their access to care and the social-medical infrastructure. The same is true in major parts of  africa as well. I am sorry if I somehow offended you- relax,

But I am worried that somehow you feel there is a universally applicable TRUTH from your experience in Florida to the rest of the world. we have all agreed that in the absence of RCT from any practice environment, that our decisions are driven by our locally acquired experiences. Now let me spell it out in the simplest terms for you to understand:

There is no RCT evidence pro or con to support your watch and wait or Erringtons and Tim's active looking. Thus I suggest that perhaps watch and wait in sophisticated urban ready access to care environments and active looking in patients from population that are not so fortunate. This may change as imaging becomes better.

If you have evidence that this attitude is wrong, state it. But don't tell me your anecdotal experience has any more validity than anybody else's

Tom

> ----------
> From: 	DocRickFry at aol.com[SMTP:DocRickFry at aol.com]
> Reply To: 	Trauma & Critical Care mailing list
> Sent: 	quinta-feira, 17 de fevereiro de 2005 12:24
> To: 	Trauma & Critical Care mailing list
> Subject: 	RE: Diaphragmatic injuries
> 
> <<File: ATT322834.txt>>
> Tom--
> Once again, you are misquoting Avi and I--we in fact see the same "subset" of patients as you and everyone else--and you would have a hard time validating your completely anecdotal assertion that  "we NEVER see these patients until their complication is FAR advanced"--we do in fact see these complications of missed injuries, and we, like all documented in the literature, find that most that we do see are not at all "far advanced" or at death's door, etc etc. You seem to be the only one with such a horrendous experience--it is so unique you should publish it. You cannot derive general principles of management from such anecdotal experience--we certainly all know the classic flaw in that.  for instance, your line of thinking carried to its logical conclusion would dictate that when we see a major complication of gastrectomy--say, blown duodenal stump, that should mean we don't do gastrectomies anymore, or that that surgeon is unsafe--see, without getting the proper perspective of how often and what is the denominator, such conclusions based on a small nukmber of anecdotes out of context are completely invalid.
> ERF
> 

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Diaphragmatic injuries