Emergency physician interpretation of head CT in trauma and suspected subarachnoid haemorrhage--is it viable? An audit of current practice.

BACKGROUND AND OBJECTIVES: The number of emergency CT head examinations has increased since the introduction of the National Institute for Health and Clinical Excellence (NICE) head injury guidelines. In addition, government targets and changes to medical training impact on how services are delivered. In this context, emergency physicians may have a role to play in the interpretation of CT head images. We have provided such a service for 10 years and set out to audit our practice to establish whether our service is safe, the nature and clinical impact of any errors and whether a similar model may be applicable elsewhere. METHOD: Audit of emergency department patients over a 27-week period comparing immediate emergency physician interpretation of unenhanced CT head images for trauma or suspected subarachnoid haemorrhage (SAH) with the subsequent neuroradiology report. The clinical significance of any discordance was assessed. RESULTS: CT head interpretations in 9/442 (2%) of trauma and 1/48 (2.1%) of suspected SAH were discordant requiring a change clinical management had the formal neuroradiology report been available immediately. Specialist advice was sought in a further 77 patients. 1/634 of the total sample came to harm. CONCLUSION: The majority of CT head imaging scans can be interpreted safely by emergency physicians in trauma and suspected subarachnoid haemorrhage. We believe a safe and viable clinical service is provided and such a model is applicable in other centres.

Trends in leprosy in the Kingdom of Bhutan, 1982-1992.

An evaluation programme was undertaken 11 years after the introduction of multidrug therapy (MDT) into Bhutan, by examining the case notes of 3239 leprosy patients who had been under treatment at any time during the period. The registered prevalence was found to have fallen markedly, as expected, and this had been accompanied by a clear fall in the case detection rate as well. The lepromatous rate among new patients rose considerably, giving epidemiological hope that the disease may be coming under control. However, no concomitant fall in the proportion of child cases was seen. The disability rate at detection rose slightly, although numbers were small. New cases were increasingly likely to have more highly positive skin smears, and to be self-reported. Programme planners should give thought to the implications of these findings.