Respectfully, that's not what the author of that blog post is suggesting.
From his post you linked:
"The implication when reviewing this literature is that well appearing, evaluable patients presenting to the Emergency Department may be harboring clinically occult, life threatening injuries undetectable by a standard physical exam. And yet this interpretation is based off methodologically flawed retrospective analyses and prospective data sets in which the physical exam was all but neglected. More importantly this ignores the multitude of clinical decision instruments, derived and validated from high quality prospective data, demonstrating that imaging can be avoided using simple components from a history and physical exam."
The author followed it later with this post:
http://emcrit.org/emnerd/case-anatomic-injury-part-ii/ which does an excellent job summarizing a recent study, the REACT-2 trial, which was a very well-done prospective study of > 1,000 trauma patients, which I think most people would say is the best data out there suggesting that pan scans as routine practice irrespective of physical exam findings / vital signs / patient complaints is
not supported by data. Check it out. Rory Spiegel is a great writer and summarizes this stuff really well, and acknowledges the critiques that some people have of the study as well.
I say all this as a PGY-2, and definitely think it's a nuanced and tricky issue. I understand that it is easier to send everyone with a concerning mechanism to the doughnut of truth and identify issues, and am sure that it does save lives in some patients that might be well-appearing until suddenly they're not. I also understand that our collaborative relationship with surgery, who will definitively manage many of these patients and take responsibility for them means their opinions are important. But I think those patients are rare -- most of the patients in whom this will identify a life-threatening injury will declare themselves in other ways, and routinely pan-irradiating every healthy young person that comes in with the label of "trauma" attached to them seems like it will lead to more harm than benefit. I'm sure my perspective will change as a function of experience and responsibility though, so I try to remain open-minded about this and appreciate all the perspectives here from the attendings and our surgical colleagues that have weighed in.
Any of you ever do shared decision making about CT with trauma patients? One of our faculty is working on this right now, I think it has potential in this population of well-appearing, awake, alert, sober patients -- ever give them a choice?
