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Mon Oct 12 04:14:29 BST 2009

There was a study by Ali Salim, et al, in Arch Surg. 2006;141:468-475,  
that seems to argue against this. His argument seems to be that the  
mechanism should drive the workup.

For example, in the discussion section after the article, the lead  
author stated, "In terms of pain in the cervical spine, we didn’t  
really address whether they had pain. We were just looking to see if  
they had any outward signs of trauma. Typically we are just looking at  
that patient who looks like they don’t have anything wrong. It is the  
typical patient that the ER physician just wants to send home from the  
ER. So in terms of cervical spine tenderness, we didn’t examine  
whether tenderness actually correlated with findings on x-ray."

Later in the discussion, he stated, "The majority of the patients that  
had their management changed was because we were able to send them  
home."

Would an IRB approve such a study today? Seems to be more and more in  
the news of late about radiation exposure with all the CT's patients  
are receiving.

...Jason

> Message: 2
> Date: Fri, 9 Oct 2009 07:09:09 -0500
> From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
> Subject: Re: "Mattox to participate in study"
> To: <trauma-list at trauma.org>
> Message-ID:
> 	<B79C02DCC4FA074DB02381DF1C5D60BA02216BBC at EX07.ad.tulane.edu>
> Content-Type: text/plain;	charset="UTF-8"
>
> Unfortunately that teaching is not well practiced  today.
> Too much is done by  protocol and not by asking that question. I  
> find that lesson the most difficult  to teach to the residents. I am  
> not sure why. Several thoughts but no answers
> Norman
>
> Typed by the thumbs of
> Norman on his BlackBerry
>
> Norman McSwain, MD
> Tulane Univ Surgery
> 504 988-5111
>
> ----- Original Message -----
> From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org>
> To: trauma-list at trauma.org <trauma-list at trauma.org>
> Sent: Fri Oct 09 07:01:15 2009
> Subject: Re: "Mattox to participate in study"
>
> May I paraphrase Ken and, therefore, simply repeat a succinct lesson  
> that my
> professors taught me 30 years ago?
>
> NO paraclinical examination should ever be ordered unless there is a  
> clear
> indication as to what the person ordering the tests expects to  
> learn, and
> how that additional new knowledge, over and above the clinical
> examination,will alter decision making and treatment.
>
> cheers from the "old school"
>
>>
>> christos giannou
> Monemvasia Lakonia
> 23070 Greece
> tel & fax: (++30) 27320-61772
> mob: (++30) 69 74 83 28 18

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