In article <00b001c24d5f$bbb61760$a0c8dec2@mccabe>, Steve Mccabe
<[log in to unmask]> writes
> Ian Stiell spoke about C-Sp clearance at Edinburgh and one of his
> messages was that midline tenderness was of no discriminant value.
>
> Of more value was the ability to rotate 45degrees in both
> directions as being highly useful in ruleout where the other
> classically taught risk factors( GCS,mechanism,distracting
> injury,neurology-symptoms or signs ) are absent.
>
> Next rules Neck rules from Ottawa
>
Yes - but have you seen them?
I have read two of the papers around this and I found it all a bit
confusing
1. Mechanism of injury is in there ( the usual sort of set) - if this
is present then they get radiography no matter what.
- they then go on to say that this will _reduce_ the number of x-rays
more than NEXUS would
2. In 2 places in one paper they attack NEXUS. This follows from their
(the Ottawa researchers) statements that many previous studies are
flawed. The technique they use to 'rubbish' NEXUS is by applying the
criteria retrospectively to their own case data - so the question that
is raised in my mind - is 'how can those who complain about methodology
use a weak technique to cast doubt on a 34000 patient RCT?'. Perhaps
the answer might that in 'sales' anything is fair and that confusing the
differences between a study of 34000 and 8000 (not sure of the exact
numbers in the Canadian study) would be a good thing in that respect???
3. The paper, which has nothing to do with ankles or knees - cites how
successful their previous ankle and knee rules have been. Sounds like a
salesman saying 'yes, buy this car because the others in the range are
the top sellers in their class'. Does this stuff have any place in
science?
I felt uneasy reading this stuff - more like 'we are better than you
are' rather than collaboration in benefiting patients and their care
systems
Cheers
--
Jel Coward
The UK Wilderness Emergency Medical Technician and Command Physician course is
10-16th November 2002 at Glenmore Lodge, Aviemore, Scotland
http://www.wildmedic.org
http://www.wemsi.org
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'There's no such thing as bad weather - just bad clothing"
Anon Norwegian
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