It is disturbing how often the same problems arise; I too was told point blank the other day by registrar
and then Consultant that a scan would not be done on a young man who had been discharged after a fall
in which he hit his head who re-presented that evening with vomiting and dizziness.
Of course, I was then obliged to admit him. I thought I would ring the radiologist the following morning
to ask him to discharge his patient but funnily enough I didn't seem able to track him down at 08:30.
There are two issues that need addressing. Firstly, how many of us need a radiologist to report head
scans? Secondly, why are we wasting an expensive and rare bed on someone when a scan is cheaper
(there are two papers showing this, one from the States, and one from Scandinavia) and has a 100%
sensitivity and 100% specificity in this setting?
A final thought. 75% of patients admitted to ERs in the States get a head scan. Here it is between 2 and
12%. A reputable source suggests that we should be scanning about 54%.
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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