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> CONCLUSION: CT is a useful test in patients with minimal head > injury because it may lead to a change in therapy in a small but > significant number of patients. Subsequent hospital observation adds > nothing to the CT results and is not necessary in patients > with isolated > minimal head injury. Thanks, Rowley. A good paper. However, has anyone taken this to its logical conclusion and actually discharged these patients? Don't want to be the first myself. > All patients had Glasgow Coma > Scale scores of 15 on arrival and had a history of either loss of > consciousness or amnesia to the event. Two hundred forty-seven patients > (21.1%) were intoxicated with drugs or alcohol on admission Does the paper go further and explain how someone who is orientated in time, place and person, spontaneously opening their eyes and obeying commands can rank as intoxicated. I suppose you can do it if pretty drowsy, but it seems to be stretching the definition of 'intoxicated' a bit. > The radiation dose is phenomenal. I'm not sure of the > millisiverts but > equivalent to 350 chest x-rays I beleive for a brain scan. > > We also have the habitual self induced head injurer who > frequently gets > p*****'ed and bangs his head. > > CT scanning is not the panacea that we are led to beleive. Good point, Danny. Met an American a few years back- a young woman of child bearing age who'd had 3 CT scans in the last 4 years (sports injury related). Makes you think. Good topic for debate and evidence hunting though- CT scanning (and indeed MRI scanning) has made little change to standard management of head injuries. Maybe it should. Related questions: 1. Anyone read the RCR 'Appropriate use of a department...' guidance that says scan every patient with a skull fracture? 2. Anyone doing it? Our radiologists don't seem keen, but it would be a help if I could come back and give a list of other departments doing it. 3. Anyone then discharging the patients? Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.