There is a problem (maybe theoretical, but not necessarily trivial) with
the two-hours window: according to the nice guidelines CT should be
requested in patients with a GCS 13 or 14 at two hours after the injury.
This implies that one knows the time of injury, which is not always the
case. What often happens is that one ends up waiting for two hours from the
time they are booked in, which is not quite the same thing.
I also would be interested in knowing why EPs in Perth decided to apply a
more prolonged window of 4 hours and if they have matched their results
with the more common 2 hours window?
Finally, what is the consensus on the potential neck (spine)injury in these
patients? Keeping in mind that some of them might be restless, not easy to
X-Ray nor to keep still in a collar, should they be immobilized while
waiting for the clinical picture to become clearer (with risk of aspiration
if vomiting) or not?
Marcello Della Corte
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