> There are two issues that need addressing. Firstly, how many
> of us need a radiologist to report head
> scans?
Most if not all of us, I'd reckon. Deciding whether to refer to
neurosurgeons I'm OK on; discharging patients is dodgier. I'd note that in
countries where they thrombolyse for stroke, it's usually a specialist
neuroradiologist, not a general radiologist who reports.
> 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?
If I'm right on this one, there's been a couple of efficacy studies but not
effectiveness studies. Does anyone know of anywhere (world-wide) that has
actually bitten the bullet and discharges patients on the basis of a normal
CT? When we discussed this after the Galasco report, I brought it up at a
local meeting that why don't we just scan patients and then it becomes
irrelevant who looks after them because they go home anyway. The people who
actually did look after head injuries felt that the evidence wasn't good
enough then. If it's better now, bring it up with your Emergency Care Lead
as a way of saving beds and at least it will get discussed at trust board
level.
Matt Dunn
Warwick
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