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Comparision of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury
478 Comment: This study adds to previous data demonstrating that elevated baseline and peak exercise NT-proBNP levels as well as increase in NT-proBNP during exercise are associated with myocardial ischemia as defined by rest/bicycle ergometry myocardial perfusion single-photon emission computed tomography. Although elevated levels of NT-proBNP are not specific to myocardial ischemia, these values may be used in conjunction with exercise EKG in the detection of myocardial ischemia.
e COMPARISION OF THE CANADIAN CT HEAD RULE AND THE NEW ORLEANS CRITERIA IN PATIENTS WITH MINOR HEAD INJURY. Stiell IG, Clement CM, Rowe BH, et al. JAMA 2005;294:1511– 8. This study from Canada examined the sensitivity and specificity of the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) in detecting the need for neurosurgical intervention and clinically important brain injury using a prospective cohort study. A total of 4348 patients were eligible for the study. Eligibility was determined by having blunt trauma to the head within 24 h of presentation resulting in witnessed loss of consciousness, definite amnesia or witnessed disorientation, and an initial ED Glasgow Coma Scale (GCS) score of 13 or greater. Of these patients, 2707 patients had completed data forms and outcome assessments. The CCHR and the NOC were compared in the cohort of patients who presented with a GCS score of 15 and the CCHR was assessed for all patients in the study using various statistical techniques. In the cohort of patients with a GCS scale of 15, both the CCHR and the NOC had sensitivities of 100% (CCHR 95% confidence interval [CI]: 63–100; NOC 95% CI: 63–100) for both neurosurgical intervention and clinically important brain injury. However, the specificities of the CCHR for neurosurgical intervention (76.3%, 95% CI: 74 –78) and clinically important brain injury (50.6%, 95% CI: 48 –53) was higher than that of the NOC for neurosurgical intervention (12.1%, 95% CI: 11–14) and clinically important brain injury (12.7%, 95% CI: 11–14). In the cohort of patients with a GCS scale of 13 or higher, the CCHR was found to have comparable sensitivities and specificities when compared to the CCHR in the limited cohort of patients with a GCS scale of 15. The authors concluded that the CCHR has the potential to improve the efficiency in the use of CT imaging for patients with minor head injuries compared to the NOC. [Yenting Chen, MD, Denver Health Medical Center, Denver, CO] Comment: Not all patients in this study underwent CT imaging. The authors addressed this by assessing patients who did not receive initial imaging through a 14-day proxy outcome measure administered by a registered nurse over the telephone. Although this study involved only Canadian physicians, the authors reported that there were few errors in interpreting the NOC. This study suggests that the criteria used in the CCHR are more accurate and reliable in evaluating patients with minor head injuries compared to the NOC.
Abstracts e WHAT TO WEAR TODAY? EFFECT OF DOCTOR’S ATTIRE ON THE TRUST AND CONFIDENCE OF PATIENTS. Rehman SU, Niertert PJ, Cope DW, et al. Am J Med 2005;118:1279 – 86. The patient-physician relationship is an extremely important concept no matter what type of medicine one practices. The above study looked at whether physician attire played an important role in helping to establish a good patient-doctor relationship. Specifically, it aimed to answer whether physician attire is important in helping patients establish trust and confidence within the patient-physician relationship. A survey was randomized to 400 outpatients and visitors in a waiting room of a veteran’s medical center internal medicine clinic. Each respondent was given a survey and a four-picture photo series depicting a physician dressed in four different attires. The four attires were as follows: 1) business attire (a suit with tie for male physician and tailored pants or skirt for a female physician); 2) professional attire (shirt, neck tie, and white coat for male, and tailored pant or skirt for female); 3) surgical scrubs for both male and female; and 4) casual attire (jeans and T-shirt for male, jeans or short skirt for female). Numerous questions were asked regarding respondents preferences about the attire and which doctor they would trust to establish a patientphysician relationship. Of the 400 respondents, 54% were white and 38% were African-American. Throughout the questions there was a clear preference toward the professional attire. Respondents overwhelmingly reported they had more confidence in and would trust the doctor depicted in the professional attire. They also reported they would be more willing to follow-up with these physicians. Of importance to Emergency Medicine, the question was asked: “Who would you prefer for an emergency (e.g., heart attack)?” Sixty-one percent of respondents still chose professional dress followed by surgical scrubs (32%). Other questions important to emergency physicians continued to support this trend. So although this is an outpatient clinic study, the results seem to indicate that the patient-physician relationship is improved by what we in the Emergency Department wear. [Aaron Eberhardt, MD, Denver Health Medical Center, Denver, CO] Comments: The way you look is important!
e THE ROLE OF THE PEDIATRICIAN IN RURAL EMERGENCY MEDICAL SERVICES FOR CHILDREN. COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE. Pediatrics 2005;116:1553– 6. The above article is a policy statement from the American Academy of Pediatrics. It helps to explain and clarify the role that pediatricians may play in emergency medical services (EMS) for rural areas. By 2000 census numbers, 25% of the population lives in rural areas. Rural children differ in their medical and surgical needs given their unique “occupational and lifestyle exposure to work- and play-related vehicles and animals.” Furthermore, these children are at an increased risk of morbidity and mortality because definitive care is located in more urban areas many miles away. Most rural EMS medical
e COMPARISION OF THE CANADIAN CT HEAD RULE AND THE NEW ORLEANS CRITERIA IN PATIENTS WITH MINOR HEAD INJURY. Stiell IG, Clement CM, Rowe BH, et al. JAMA 2005;294:1511– 8. This study from Canada examined the sensitivity and specificity of the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) in detecting the need for neurosurgical intervention and clinically important brain injury using a prospective cohort study. A total of 4348 patients were eligible for the study. Eligibility was determined by having blunt trauma to the head within 24 h of presentation resulting in witnessed loss of consciousness, definite amnesia or witnessed disorientation, and an initial ED Glasgow Coma Scale (GCS) score of 13 or greater. Of these patients, 2707 patients had completed data forms and outcome assessments. The CCHR and the NOC were compared in the cohort of patients who presented with a GCS score of 15 and the CCHR was assessed for all patients in the study using various statistical techniques. In the cohort of patients with a GCS scale of 15, both the CCHR and the NOC had sensitivities of 100% (CCHR 95% confidence interval [CI]: 63–100; NOC 95% CI: 63–100) for both neurosurgical intervention and clinically important brain injury. However, the specificities of the CCHR for neurosurgical intervention (76.3%, 95% CI: 74 –78) and clinically important brain injury (50.6%, 95% CI: 48 –53) was higher than that of the NOC for neurosurgical intervention (12.1%, 95% CI: 11–14) and clinically important brain injury (12.7%, 95% CI: 11–14). In the cohort of patients with a GCS scale of 13 or higher, the CCHR was found to have comparable sensitivities and specificities when compared to the CCHR in the limited cohort of patients with a GCS scale of 15. The authors concluded that the CCHR has the potential to improve the efficiency in the use of CT imaging for patients with minor head injuries compared to the NOC. [Yenting Chen, MD, Denver Health Medical Center, Denver, CO] Comment: Not all patients in this study underwent CT imaging. The authors addressed this by assessing patients who did not receive initial imaging through a 14-day proxy outcome measure administered by a registered nurse over the telephone. Although this study involved only Canadian physicians, the authors reported that there were few errors in interpreting the NOC. This study suggests that the criteria used in the CCHR are more accurate and reliable in evaluating patients with minor head injuries compared to the NOC.
Abstracts e WHAT TO WEAR TODAY? EFFECT OF DOCTOR’S ATTIRE ON THE TRUST AND CONFIDENCE OF PATIENTS. Rehman SU, Niertert PJ, Cope DW, et al. Am J Med 2005;118:1279 – 86. The patient-physician relationship is an extremely important concept no matter what type of medicine one practices. The above study looked at whether physician attire played an important role in helping to establish a good patient-doctor relationship. Specifically, it aimed to answer whether physician attire is important in helping patients establish trust and confidence within the patient-physician relationship. A survey was randomized to 400 outpatients and visitors in a waiting room of a veteran’s medical center internal medicine clinic. Each respondent was given a survey and a four-picture photo series depicting a physician dressed in four different attires. The four attires were as follows: 1) business attire (a suit with tie for male physician and tailored pants or skirt for a female physician); 2) professional attire (shirt, neck tie, and white coat for male, and tailored pant or skirt for female); 3) surgical scrubs for both male and female; and 4) casual attire (jeans and T-shirt for male, jeans or short skirt for female). Numerous questions were asked regarding respondents preferences about the attire and which doctor they would trust to establish a patientphysician relationship. Of the 400 respondents, 54% were white and 38% were African-American. Throughout the questions there was a clear preference toward the professional attire. Respondents overwhelmingly reported they had more confidence in and would trust the doctor depicted in the professional attire. They also reported they would be more willing to follow-up with these physicians. Of importance to Emergency Medicine, the question was asked: “Who would you prefer for an emergency (e.g., heart attack)?” Sixty-one percent of respondents still chose professional dress followed by surgical scrubs (32%). Other questions important to emergency physicians continued to support this trend. So although this is an outpatient clinic study, the results seem to indicate that the patient-physician relationship is improved by what we in the Emergency Department wear. [Aaron Eberhardt, MD, Denver Health Medical Center, Denver, CO] Comments: The way you look is important!
e THE ROLE OF THE PEDIATRICIAN IN RURAL EMERGENCY MEDICAL SERVICES FOR CHILDREN. COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE. Pediatrics 2005;116:1553– 6. The above article is a policy statement from the American Academy of Pediatrics. It helps to explain and clarify the role that pediatricians may play in emergency medical services (EMS) for rural areas. By 2000 census numbers, 25% of the population lives in rural areas. Rural children differ in their medical and surgical needs given their unique “occupational and lifestyle exposure to work- and play-related vehicles and animals.” Furthermore, these children are at an increased risk of morbidity and mortality because definitive care is located in more urban areas many miles away. Most rural EMS medical