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Intuition, Bedside Skills Rival New Technology

Mon, 12/21/2009 - 5:31am

According to a Loyola University Health System study, a simple bedside exam performed by a physician or surgeon after brain surgery can be superior to a CT scan, especially in predicting which patients would need to return to the operating room to treat complications such as bleeding.

Patients typically receive CT scans following open brain surgery to remove tumors, repair aneurysms or treat injuries, but CT scans can cost hundreds of dollars and expose patients to radiation. Additionally, transporting patients to scanning machines involves multiple personnel and nursing staff who are taken away from their other responsibilities, the researchers wrote.

The lead author of the study is Dr. Ahmad Khaldi, chief resident in the Department of Neurological Surgery 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. Of these, 133 received routine scans within seven hours of surgery and 108 patients who received routine scans between eight 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 confirmed the patients' problems were serious enough to require a return to the operating room. By comparison, 0 percent of the 241 routine CT scans predicted whether patients would have to return to the emergency room.

A normal CT scan 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.”

Sources: Journal of Neurosurgery

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