Doctors' bedside skills trump medical technology

December 18, 2009

Sometimes, a simple bedside exam performed by a skilled physician is superior to a high-tech CT scan, a Loyola University Health System study has found.

Researchers found that physicians' bedside exams did a better job than CT scans in predicting which patients would need to return to the operating room to treat complications such as bleeding.

"The low cost, simple, but elegant neurological exam appears to be superior to a routine CT scan in determining return to the operating room," researchers report in the Journal of Neurosurgery.

Patients typically receive CT scans following open to remove tumors, repair aneurysms, treat brain injuries, etc. But practices vary. Some surgeons order CT scans right after surgery. Others wait until the following morning.

There are downsides. CT scans cost hundreds of dollars and expose patients to radiation. Transporting patients to scanning machines "involves multiple personnel of varying skills and nursing staff who are taken away from their other unit responsibilities," researchers wrote. "These scans also often interfere with work flow efficiencies of the radiology department."

The lead author of the study is Dr. Ahmad Khaldi, chief resident in the Department of at Loyola University Chicago Stritch School of Medicine. The senior author is Dr. Thomas Origitano, chairman of the Department of Neurological Surgery.

Researchers examined the records of 251 patients who received CT scans within 24 hours of surgery at Loyola. They included 133 patients who received routine scans within seven hours of surgery and 108 patients who received routine scans between 8 hours and 24 hours after surgery. None of the routine scans predicted which patients would need to return to the operating room.

Patients also received bedside neurological exams by physicians. In 10 cases, physicians detected serious problems, such as being slow to wake up, that warranted an urgent CT scan. Three of these urgent scans (30 percent) confirmed the patients' problems were serious enough to require a return to the . By comparison, 0 percent of the 241 routine CT scans predicted whether patients would have to return to the emergency room.

A normal given right after surgery might give a doctor a false sense of security, which could lead to less frequent monitoring and neurological exams. Of the 14 patients in the study who took a serious turn for the worse, 13 had had CT scans within four hours of surgery that were normal or showed only minor problems.

"Scanning technology is really good," Origitano said. "But applying it without a physician's input is not necessarily helpful."

Explore further: New scans improve treatment accuracy

Related Stories

New scans improve treatment accuracy

September 14, 2006

Australian doctors say they have developed new scans that can that quickly show whether breast cancer cells are responding to therapy.

CT scans to determine heart disease in the emergency room

November 27, 2007

In the future, patients who arrive at a hospital Emergency Department complaining of chest pain may be diagnosed with a sophisticated CT scan. If the diagnosis is negative, the patient can go home—and the total time at ...

Hazards of CT scans overstated

December 1, 2007

Concerns over possible radiation effects of CT scans detailed in a report yesterday in the New England Journal of Medicine should not scare people away from getting medically needed CT scans, as the scans play a critical ...

Study: CT scans rule out heart attacks faster

November 18, 2009

(AP) -- A new study suggests that a type of "super X-ray" can give a faster, cheaper way to tell whether a chest pain sufferer is really having a heart attack.

Recommended for you

How the finch changes its tune

August 3, 2015

Like top musicians, songbirds train from a young age to weed out errors and trim variability from their songs, ultimately becoming consistent and reliable performers. But as with human musicians, even the best are not machines. ...

Machine Translates Thoughts into Speech in Real Time

December 21, 2009

( -- By implanting an electrode into the brain of a person with locked-in syndrome, scientists have demonstrated how to wirelessly transmit neural signals to a speech synthesizer. The "thought-to-speech" process ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.