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I look forward to critically reviewing the Sevadei data, as this runs
entirely contrary to my experience. I agree that my 'scan at 4 hours of
symptoms in mild head trauma' is conservative, but though I am a strong
advocate of the sensitivity of physical exam, most authors on this topic
disagree with me. The fact is that no one has clearly delineated what
percentage of PE- negative, 'symptomatic at 4 hours', head injury
patients have operable lesions. Seven years out of training, I have had
two 'minor head injury', symptomatic patients whose only PE findings at
2-3 hours post injury was ataxia, that required craniotomy. At times I
am admittedly 'untroubled by doubt', but I'm not absolutely certain I
could have distinguished those two cases from the approximately 300
'clinically similar' patients I have had who were CT negative. I wish I
would be the one that will prove that careful PE can distinguish these
two subsets, but I won't. I understand that there are a couple of
well-designed, on-going studies on this topic.
 
Jay Fisher
 
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