- Email: [email protected]
Letter to “Management of motorcycle accident–related blunt hepatic injury—a different strategy”
Correspondence
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[5]
[6]
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[8]
section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 2000;217:447-55. Coche E, Verschuren F, Keyeux A, Goffette P, Goncette L, Hainaut P, et al. Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy. Radiology 2003;229:757-65. Chartrand-Lefebvre C, Howarth N, Lucidarme O, Beigelman C, Cluzel P, Mourey-Gérosa I, et al. Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience. AJR Am J Roentgenol 1999; 172:107-12. Courtney DM, Miller C, Smithline H, Klekowski N, Hogg M, Kline JA. Prospective multicenter assessment of interobserver agreement for radiologist interpretation of multidetector computerized tomographic angiography for pulmonary embolism. J Thromb Haemost 2010;8:533-9. Domingo ML, Martí-Bonmatí L, Dosdá R, Pallardó Y. Interobserver agreement in the diagnosis of pulmonary embolism with helical CT. Eur J Radiol 2000;34:136-40. Richman PB, Dominguez S, Kasper D, Chen F, Friese J, Wood J, et al. Interobserver agreement for the diagnosis of venous thromboembolism on computed tomography chest angiography and indirect venography of the lower extremities in emergency department patients. Acad Emerg Med 2006;13:295-301.
119 are also prone to have other associated injuries, which make their injury severity score higher than other mechanisms of injuries. However, patients with higher injury severity score may need to be observed in the intensive care unit rather than the ordinary ward. I argue that favorable results of their patients may be due to exclusion of more severely injured patients, including those died in the ED, had been transferred to other facilities, or had other types of trauma requiring surgery. Nevertheless, I would like to know, if the patient does not receive angioembolization, will the rebleeding rate increase? Besides, is the grade of laceration associated with speed during collision in their patients? This is an interesting article, and I am looking forward to their reply. Jiun-Nong Lin MD Department of Emergency Medicine E-Da Hospital/I-Shou University Kaohsiung County 824, Taiwan E-mail address: [email protected] doi:10.1016/j.ajem.2010.09.002
Interobserver agreement in computer tomography readings for pulmonary embolism
Reference [1] Lin HL, Lee KT, Chen CW, et al. Management of motorcycle accident– related blunt hepatic injury—a different strategy. Am J Emerg Med 2010;28:177-82.
To the Editor, We would like to thank the authors for the positive comments to our work. Moreover, we appreciated very much the additional data they cited that are of help in completing our study. Therefore, we agreed with all the points raised, and we hope that further studies on a larger scale may verify the utility of a second “expert” radiologic opinion in the cases of nonmassive pulmonary embolism.
A response to a letter regarding the article “Management of motorcycle accident–related blunt hepatic injury—a different strategy” To the Editor,
Giorgio Costantino MD Anna Maria Rusconi MD Nicola Montano MD Medicina II. Ospedale L. Sacco Università degli Studi di Milano, Milan, Italy doi:10.1016/j.ajem.2010.08.015
Letter to “Management of motorcycle accident–related blunt hepatic injury—a different strategy” To the Editor, Lin et al [1] reported a different strategy to management of motorcycle accident–related blunt hepatic injury. They concluded that patients with stable hemodynamics may be observed safely on an ordinary ward rather than in the intensive care unit, especially those with lower grade blunt hepatic injury. In addition, they also found that motorcyclists
We are grateful that our article, “Management of motorcycle accident–related blunt hepatic injury—a different strategy” [1] has drawn the attention of your readers and generated some queries, and we would like to comment on the response generated by our original article. In the letter, the authors disagree with our conclusion that “patients with stable hemodynamics may be observed safely on an ordinary ward rather than in the intensive care unit (ICU), especially those with lower grade blunt hepatic injury patients,” and firstly argue that our favorable results might have come from exclusion of severely injured patients who either died in the ED, had been transferred to other facilities, or had other types of trauma requiring surgery. We would like to emphasize that, as we have mentioned in our article, the reason for a different strategy was the different group of patients we were managing. Although we excluded the above-mentioned patients, there was no effect on the severity of our selected group. The study object in our article was management of blunt hepatic injury of motorcyclists. If patients died from a motorcycle accident in the ED, the exact extent of their injuries
[4]
[5]
[6]
[7]
[8]
section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 2000;217:447-55. Coche E, Verschuren F, Keyeux A, Goffette P, Goncette L, Hainaut P, et al. Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy. Radiology 2003;229:757-65. Chartrand-Lefebvre C, Howarth N, Lucidarme O, Beigelman C, Cluzel P, Mourey-Gérosa I, et al. Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience. AJR Am J Roentgenol 1999; 172:107-12. Courtney DM, Miller C, Smithline H, Klekowski N, Hogg M, Kline JA. Prospective multicenter assessment of interobserver agreement for radiologist interpretation of multidetector computerized tomographic angiography for pulmonary embolism. J Thromb Haemost 2010;8:533-9. Domingo ML, Martí-Bonmatí L, Dosdá R, Pallardó Y. Interobserver agreement in the diagnosis of pulmonary embolism with helical CT. Eur J Radiol 2000;34:136-40. Richman PB, Dominguez S, Kasper D, Chen F, Friese J, Wood J, et al. Interobserver agreement for the diagnosis of venous thromboembolism on computed tomography chest angiography and indirect venography of the lower extremities in emergency department patients. Acad Emerg Med 2006;13:295-301.
119 are also prone to have other associated injuries, which make their injury severity score higher than other mechanisms of injuries. However, patients with higher injury severity score may need to be observed in the intensive care unit rather than the ordinary ward. I argue that favorable results of their patients may be due to exclusion of more severely injured patients, including those died in the ED, had been transferred to other facilities, or had other types of trauma requiring surgery. Nevertheless, I would like to know, if the patient does not receive angioembolization, will the rebleeding rate increase? Besides, is the grade of laceration associated with speed during collision in their patients? This is an interesting article, and I am looking forward to their reply. Jiun-Nong Lin MD Department of Emergency Medicine E-Da Hospital/I-Shou University Kaohsiung County 824, Taiwan E-mail address: [email protected] doi:10.1016/j.ajem.2010.09.002
Interobserver agreement in computer tomography readings for pulmonary embolism
Reference [1] Lin HL, Lee KT, Chen CW, et al. Management of motorcycle accident– related blunt hepatic injury—a different strategy. Am J Emerg Med 2010;28:177-82.
To the Editor, We would like to thank the authors for the positive comments to our work. Moreover, we appreciated very much the additional data they cited that are of help in completing our study. Therefore, we agreed with all the points raised, and we hope that further studies on a larger scale may verify the utility of a second “expert” radiologic opinion in the cases of nonmassive pulmonary embolism.
A response to a letter regarding the article “Management of motorcycle accident–related blunt hepatic injury—a different strategy” To the Editor,
Giorgio Costantino MD Anna Maria Rusconi MD Nicola Montano MD Medicina II. Ospedale L. Sacco Università degli Studi di Milano, Milan, Italy doi:10.1016/j.ajem.2010.08.015
Letter to “Management of motorcycle accident–related blunt hepatic injury—a different strategy” To the Editor, Lin et al [1] reported a different strategy to management of motorcycle accident–related blunt hepatic injury. They concluded that patients with stable hemodynamics may be observed safely on an ordinary ward rather than in the intensive care unit, especially those with lower grade blunt hepatic injury. In addition, they also found that motorcyclists
We are grateful that our article, “Management of motorcycle accident–related blunt hepatic injury—a different strategy” [1] has drawn the attention of your readers and generated some queries, and we would like to comment on the response generated by our original article. In the letter, the authors disagree with our conclusion that “patients with stable hemodynamics may be observed safely on an ordinary ward rather than in the intensive care unit (ICU), especially those with lower grade blunt hepatic injury patients,” and firstly argue that our favorable results might have come from exclusion of severely injured patients who either died in the ED, had been transferred to other facilities, or had other types of trauma requiring surgery. We would like to emphasize that, as we have mentioned in our article, the reason for a different strategy was the different group of patients we were managing. Although we excluded the above-mentioned patients, there was no effect on the severity of our selected group. The study object in our article was management of blunt hepatic injury of motorcyclists. If patients died from a motorcycle accident in the ED, the exact extent of their injuries