Not the same! CT involves large dose of radiation, ECG
does not!
--> I was using ECG as an example. I don't wish to confuse the issues as I
think the radiation dose is NOT a factor here at all. No, I am not going to
stand here (electronically speaking) and say that "I have never seen those
millions of sufferers of radiation sickness or whatever from too many
CTs"... I simply mean that, according to what I understood even from YOU, CT
would be acceptable if it changed management, no? If it brought on an early
discharge, it would be justified, right? I agree with that, as do most, I am
sure, despite the radiation risk (or, for that matter, the cost).
Well I never saw anyone discharged after a negative
scan!
--> You seem to be unique there. I am sure that someone on this list has
done/seen this very event in their own departments even since you first
stated you had not, say a couple of days back.
>
Agreed, but that doesn't mean just because we have
that toll we have to use it every time, particularly
when that tool involves exposure to a significant dose
of radiation. I was brought up on the principle that
you should only request an investigation if the result
was going to alter your management. Whether the result
you are looking for is a positive or negative one is
irrelevant. If early negative scans lead to a change
in management - such as early discharge then it is
justified, if it doesn't then surely you need to
explore the reasons for doing it.
--> 100% agree! Fred, to cut this short... It seems that we are ALL in
agreement that an early CT is OK if it helps with an early discharge. It
just seems you have not come across it. Yet.
I am at a loss to offer any better way to repair this absence of anecdotal
evidence other than to suggest that, should you have a case with a recent
head injury, minor amnesia/LOC, (etc, as per whichever guideline you use)
and you decide the patient is neurologically NAD, sober, etc. you ask
yourself:
If I knew there was no bleed big enough to see in this patient's head, would
I be happy to discharge? Answer "yes"? Then do an early CT right then and
dishcarge if no bleed/lesion is seen.
If, on the other hand, you find someone (and it seems you have) who does all
the above, gets a negative CT and then still admits for observation, ask
that someone to draw you a graph showing the evidence he/she has, with
length of observation post-normal CT in hours on the X axis and on the
Y-axis some measurement of outcome showing a benefit...
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