Doctors' bedside skills trump medical technology

Dec 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 technique uses a genetic tool and light to view and map neuronal circuits

add to favorites email to friend print save as pdf

Related Stories

CT scans to determine heart disease in the emergency room

Nov 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

Dec 01, 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 role i ...

New scans improve treatment accuracy

Sep 14, 2006

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

Recommended for you

'Dimmer switch' for mood disorders discovered

6 hours ago

Researchers at University of California, San Diego School of Medicine have identified a control mechanism for an area of the brain that processes sensory and emotive information that humans experience as ...

How stress tears us apart

15 hours ago

Why is it that when people are too stressed they are often grouchy, grumpy, nasty, distracted or forgetful? Researchers from the Brain Mind Institute (BMI) at EPFL have just highlighted a fundamental synaptic ...

User comments : 0