Sorry Rowley, but don't the recent NICE guidelines suggest CT cervical spine
for the following:
GCS < 13 on arrival to ED (or patient intubated)
or
Patient being scanned for multi-region trauma
or have I misinterpreted your meaning? Anyway, we no longer carry out plain
c-spine films for these types of cases, but instead go straight for CT, and
our radiologists are "happy" with that arrangement (are radiologists ever
happy?).
Good debate, by the way. Agree we need to move towards more imaging in
trauma patients. Agree that patients are more likely to suffer harm as a
result of delayed imaging/decision making than not, and that the benefits of
CT in trauma easily outweigh the downside associated with transfer to scan
or with radiation dosage (has anyone ever had 1000 abdominal CTs?).
And finally, radiologists/radiographers "asleep in bed at home" is not an
acceptable argument to avoid scanning such patients!
Regards
AF
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, February 06, 2008 9:18 PM
Subject: Re: Resus gantries / DR
We have great difficulty in persuading our imaging colleagues to undertake
CT neck without a plain lateral neck film. Your comment suggests you do not
have this problem.
Best Wishes,
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Doc Holiday
Sent: 06 February 2008 20:46
To: [log in to unmask]
Subject: Re: Resus gantries / DR
From: [log in to unmask]
> ...Three low-quality radiographs per patient...
--> I don't disagree with your questioning of how "necessary" an
--> overhead gantry is.
But why THREE radiographs?? I can work out two...
> we should be moving to whole-body CT for multiple trauma
--> Although this change will take time, as EDs are built/re-designed,
--> it will be interesting to see what effect the increased availability of
RAPID-CT-adjacent-to-resus has not only on reducing plain films (your point)
but also reducing the use of FAST. With CT scanner only a couple of metres
away from the trauma bay and portable monitors and full trauma teams and
pre-hospital primary surveys and permissive-hypotensive-resuscitation and
airway management, etc - all these advances seem to point to a reduction in
the classic contra-indication to CT of the "doughnut of death"... We already
lack the main "indication" for the use of EM ultrasound in the UK which they
have in the USA - being able to "bill" for it ;-)
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