I am sorry to have to return to the subject. Although I admire the effort of
Stiell and coworker and I am impressed by the size of the population they studied,
I believe I have the right to decide whether their study represents satisfactory
evidence upon which to base my practice, by analyzing their methods.
I already made my points clear about the flaws in their study in a previous
E-mail and I am not willing to repeat myself here. I have also explained why
I believe that the flaws in this study are significant, rather than negligible.
The authors' reply to some of the objections they received it is less than satisfactory,
too.
The Canadian head rule does not include, for example, headache, raised systolic
pressure, lethargy, vertigo. What do you do with these patients? I have a very
low threshold for scanning them, despite their GCS, if their symptoms persist.
I have nothing to say about the reviewers of the Lancet. However, you seem to
destroy the very principle of critical appraisal. If I have to accept whatever
has been written in a journal simply because the reviewers have already done
the appraisal for me, why do they publish a section called materials and methods?
They could just as well publish only the title and the conclusions saving me
the bother to read all the rest.
M. Della Corte
Staff Grade ED
Oxford
-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]]
On Behalf Of Andrew Webster
Sent: 16 February 2002 14:33
To: [log in to unmask]
Subject: Re: radilogical imaging of head injury
I would be interested in what evidence you base your decision making. If
you CT more than Canadian rule would suggest then you must have a very low
threshold for scanning. Do you scan every head injury, and have you
audited your yield of positive scans. If you are doing so well why not
submit your protocol to EBM review.
I have read the paper and though it has flaws, it is enrolled a large
population, and was structered to minimise flaws. You would also hope that
the statisticians and reviewers in the Lancet are talented enough in
EBM/critical appraisal to make a valid judgement to know whether or not
its findings are valid.
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