In message <[log in to unmask]>, Andrew Mowat
<[log in to unmask]> writes
>aren't you now worried about the
>Regulations regarding X-Rays, and the use of Royal College of
>Radiologist Guidelines regarding exposure to X-Rays - criteria are now
>either "fulfilled" or not.
That's the problem with the guideline / protocol-driven world we live in: guidlines
are black & white, whereas patients are grey. Guidelines protect the patient from
under- and over-XRaying, and protect us from accusations of under- or over-Xraying.
IMHO the C-spine guidelines that include "lack of pain-free FROM" as an indication
are erring too much on the side of caution, or perhaps I'm interpreting them too
cautiously. What do you do?. I still follow them for MY protection and perhaps for
patients too (if one ever turns up positive its obviously worth it for that
patient). Wish they were all as simple, useful and straightforward as Ottawa.
The C-spine protocol we (and most others) use generates a huge number of normal C-
spine XRays (and exposes patients to radiation) for the very occasional positive
pick-up presumably - i'm still waiting for my 1st. The risk to an INDIVIDUAL from an
XRay for a low clinical suspicion may be negligible, but is the cumulative risk on
the population from hundreds / thousands of normal C-spines in the "slight
suspicion" group justified by the remote chance you might pisk something significant
up? This is not a rhetorical question. The easy answer is: "even 1 in a million
positive Xrays justifies Xraying the other 999,999", but I'm not convinced that it
is as simple as this. I'm still waiting for someone to tell me the incidence of
positive C-spine XRays in the minimally symptomatic patients we see most of.
Anyone clever fancy doing a "best BETS" on the clinical question:
A 17 year old woman falls off her horse / had a low-impact RTA, is not knocked out,
has no neuro features, no distracting injuries, no midline neck tenderness but has a
10% reduction of neck movements due to slight discomfort at extremes of movement.
You order a C-spine Xray according to guidelines. You wonder what the chance is of a
significant positive finding on the XRay?
Dr G Ray
Staff Grade
A&E
Sussex
Reply to [log in to unmask]
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|