I can think of situations where on minimal clinical grounds X-Ray exams were
taken with highly significant findings.
I suggest that in managing patients who are truly GCS 15 X-Ray exams should
be considered even in the absence of localised clinical findings where:
the history is "alarming"
the mechanism of injury is "alarming"
a significant distracting injury is present
patient is on long term steroids / bony disease i.e. rheumatoid arthritis
Although the original question refers to GCS 15 patients - those who are
chronically less than 15 i.e. mental handicap / chronic confusional states
etc. also need special consideration in terms of X-Ray exams.
I think these suggestions fit with the emphasis of ATLS in attaching
over-riding importance to the clinical assessment.
Charlie Fee
Craigavon
N.Ireland
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