Posters for accident departments

Letters to the Editor POSTERS FOR ACCIDENT

DEPARTMENTS

Table Date

Sir, In Aintree Hospital Trust, 62% of attenders at an Accident and Emergency Department undergo radiographic examination. Concern has been expressed regarding the high radiology workload and inappropriate patient exposure to radiation.’ Posters in accident and emergency departments have been recently been shown to be successful in reducing the number of unnecessarily taken skull and abdominal radiographs.’ We studied the effect of introducing a poster outlining indications for facial views in cases of suspected fractured zygoma. Two posters were placed in prominent locations in the Accident and Emergency Department of Fazakerley Hospital, Liverpool (Fig). The posters were coloured and measured 50 x 70 cm and of similar design to those used by McNally? et al 1995. The posters were introduced on August 1 1995 to coincide with the new intake of A&E SHOs. During the induction lectures to these SHOs a talk on maxillofdcial trauma was given as is usual at this time. In addition the purpose of the posters was explained. The effect of the poster was evaluated after 6 months. The number of facial views taken during this period was determined and compared with the number taken in the period August I 1994 to February 1 1995 when no poster was present in the department. The results are presented in the Table. The results were analysed using the Chi square test. The introduction of a poster did not significantly reduce the number of referrals for facial views (0.05
Total A&E attendance\

1I8194 -l/2/95 l/8/95 -l/2/96

vary markedly between these periods. The possibility that the poster guidelines resulted in facial fractures being missed was considered unlikely as more mid-facial fractures were operated on during the period when the poster was in situ (107 compared with 95). No change in referral patterns following introduction of poster guidelines has been observed with regard to ankle and cervical spine radiographs? and facial views would seem to fall into the same category. Reasons for this are difftcult to identify. In any event a more successful strategy may be to attempt to reduce the number of facial views taken per patient. The efficacy of one occipitomental view in diagnosing facial fractures has previously been demonstrated in this Journal?“.’ This simple measure would reduce exposure to radiation considerably in those patients with facial injuries. Carl Jones Senior Registrar

in Oral and Maxillofacial

Surgery

Simon Rogers Senior Registrar

in Oral and Maxillofacial

Surgery

Huw Lewis-Jones Consultant Radiologist Walton Hospital Liverpool

Facial ,Ti~~ma. w& Numb cheek ,I _-. Diplopia

(f3) Defer X-ray in the patient who is unco$&a& to be admitted or who has a possible cervical spine injury. Example

of poster

displayed

in A&E

Department,

Fazakerley

688 (1 .S’:;,) 641 (1 Ma)

KJ = 3. I I

ctures Of The Zygoma ....wnen to

Fig.

38 479 39 458

Number ol Facial views

Hospital. 453

l

Liverpool

454

British

Journal

of Oral and Maxillofacial

Surgery

References 1. Fowkes FGR. Strategies for changing the use of diagnostic radiology. London: King’s Fund, 1986. 2. McNally E, de Lacey G, Love11P, Welch T. Posters for accident departments: a simple method of sustaining reduction in X ray examinations. Br Med J 1995; 310: 640-642. 3. Rogers SN, Bradley S, Michael SP The diagnostic yield of only one occipitomental radiograph in cases of suspected mid-facial trauma. Br J Oral Maxillofacial Surg 1995; 33: 90-92. 4. Rogers SN, Allen PE. The diagnostic yield of only one occipitomental radiograph in cases of suspected mid-facial trauma. Br J Oral Maxillofacial Sure 1995: 33: 130. 5. Sidebottom AJ, Cornelius P, Allen FE, Cobby M, Rogers SN. Routine post-traumatic radiographic screening of mid-facial injuries. Is one view sufficient? Injury 1997; 27: 311-313.

INJURY RESEARCH LEADS TO NATIONAL GLASS REPLACEMENT INITIATIVE

Demaglass, the leading UK glass manufacturer, will be launching their new toughened glass range to coincide with the BJOMS Facial Injury AwarenessWeek in February 1998. J. l? Shepherd Professor of Oral and Maxillofacial Surgery University of Wales College of Medicine Cardiff, UK

Sir, Re: Bronshtein M, Blutnenfeld I, Blumenfeld Z. Early prenatal diagnosis of cleft lip and its potential impact on the number of babies with cleft hp. Br J Oral Maxillofac Surg 1996; 34: 486-487. What a tragedy for the parents, child, and all the professionals involved for not being successfulin preventing the abortion. It is crime for parents to terminate a pregnancy because of the cleft on the lip and palate, no lessthan for an isolated cleft palate. The surgeon should be held responsible for not successfully counseling the parents, to enable them to accept the child with such a minor defect. It is essential that a properly staffed cleft palate craniofacial program be organized with trained psychological workers who are able to successfullycommunicate with parents. It is obvious that, in this case, the surgeons have failed in their professional/social responsibilities. Samuel Berkowitz DDS, MS, FICD Clinical Professor of Pediatrics and Surgery Orthodontist, South Florida Cleft Palate Clinic, 6601 South West 80th Street South Miami, Florida 33143, USA

Sir, Beginning in the mid 1980s research carried out by my research group in Cardiff and Bristol has shown that violence has become the leading cause of serious facial injury in the UK. The team’s research has discovered that bar glasswareis an important source of permanently disfiguring injury and that the risk of injury can be reduced substantially by the use of toughened bar glassware, particularly toughened one pint glasses. In a presentation to the British Parliamentary All Party Group on Alcohol Misuse on 9 July 1996, I explained that this research had led to major new investment in toughened glass by a leading bar glass manufacturer in the UK and to local authorities making the use of toughened glassware a condition of a drinks licence. This research has prompted the Chairman of the All Party Group, Mr Don Touhig, to ask the Secretary of State for the Home Department about government plans to require the bar trade to use toughened glassware. Subsequently, this proposal was adopted by the new Home Secretary, Jack Straw, in his initiative to tackle alcohol-related crime, ‘Calling Time’. My injury research group has recently attracted two research grants (&I95 000) from the Alcohol Education & Research Council and from the National Health Service Research & Development Scheme to fund studies of the effectiveness of means of preventing alcohol-related injury and post traumatic stressdisorder. Partners in this research are Professor Frank Fincham and Professor Ray Hodgson and Dr Jonathan Bisson (Psychology, Card%) (Psychological Medicine, Cardiff).

MANAGEMENT DYSFUNCTION

OF VELOPHARYNGEAL

Sir, I was a little confused by the concluding remark in the article by Sell and Ma (A model of practice for the management of velopharyngeal dysfunction. Br J Oral Maxillofac Surg 1996; 34: 357-363). The authors first of all state that there is no evidence to show any relationship between volume of surgery and outcome, but then claim that there is indeed ‘some evidence that a close correlation exists between quality of outcome and availability of high volume centralised care by dedicated teams’. As far as I am aware, there is no evidence to support this claim and the two references that have been quoted offer opinions and no objective scientific date to support such a claim. I only hope that readers sift through the propaganda and examine what little objective scientific data is, at present, available on this subject. The inclusion of these comments by the authors is unfortunate as the rest of the paper is very interesting and informative. C. N. Penfold Consultant Oral and Facial Surgeon Wrexham Maelor Hospital NHS Trust Wrexham, UK