There are times when a simple bedside exam is superior to a high-tech CT scan. Researchers at Loyola University Health System found that beside exams conducted by skilled physicians 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 brain surgery to remove tumors, repair aneurysms, treat brain injuries, etc. But practices vary from surgeon to surgeon. Some order CT scans right after surgery. Others wait until the following morning.
There are downsides to high-tech scans. CT scans cost hundreds of dollars and expose patients to radiation, which recent studies show can cause tens of thousands of new cancer cases each year. Transporting patients to and from scanning machines takes personnel away from other duties.
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 operating room. By comparison, none of the 241 routine CT scans predicted whether patients would have to return to the emergency room.
Researchers fear that a normal CT scan conducted immediately following 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," Dr. Thomas Origitano, chairman of the Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine, said in a statement. "But applying it without a physician's input is not necessarily helpful."
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