This one looked pretty convincing to me:
J Trauma 1999 Feb;46(2):268-70
The utility of head computed tomography after minimal head injury.
Nagy KK, Joseph KT, Krosner SM, Roberts RR, Leslie CL, Dufty K, Smith
RF, Barrett J.
Department of Trauma, Cook County Hospital, Rush University, Chicago,
Illinois, USA. [log in to unmask]
OBJECTIVE: To determine if patients who present with a history of loss
of consciousness who are neurologically intact (minimal head injury)
should be managed with head computed tomography (CT), observation, or
both. METHODS: We prospectively studied patients who presented to our
urban Level I trauma center with a history of loss of consciousness
after blunt trauma and a Glasgow Coma Scale score of 15. All patients
underwent CT of the head and were subsequently admitted for 24 hours of
observation. RESULTS: A total of 1,170 patients with minimal head injury
were studied during a 35-month period. 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; 39 patients
(3.3%) had abnormalities detected by CT, including 18 intracranial
bleeds; 21 patients (1.8%) had changes in therapy as a direct result of
their CT results, including 4 operative procedures. No patient with
negative CT results deteriorated during the subsequent observation
period. 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.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
ACCIDENT & EMERGENCY - SwarkHosp-TR
Sent: 16 September 2002 15:03
To: [log in to unmask]
Subject: Re: radiologists compromise timely emergency care
> There are two issues that need addressing. Firstly, how many of us
> need a radiologist to report head scans?
Most if not all of us, I'd reckon. Deciding whether to refer to
neurosurgeons I'm OK on; discharging patients is dodgier. I'd note that
in countries where they thrombolyse for stroke, it's usually a
specialist neuroradiologist, not a general radiologist who reports.
> Secondly, why are we wasting an expensive and rare bed
> on someone when a scan is cheaper
> (there are two papers showing this, one from the States, and one from
> Scandinavia) and has a 100% sensitivity and 100% specificity in this
> setting?
If I'm right on this one, there's been a couple of efficacy studies but
not effectiveness studies. Does anyone know of anywhere (world-wide)
that has actually bitten the bullet and discharges patients on the basis
of a normal CT? When we discussed this after the Galasco report, I
brought it up at a local meeting that why don't we just scan patients
and then it becomes irrelevant who looks after them because they go home
anyway. The people who actually did look after head injuries felt that
the evidence wasn't good enough then. If it's better now, bring it up
with your Emergency Care Lead as a way of saving beds and at least it
will get discussed at trust board level.
Matt Dunn
Warwick
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