Physician Skills Better Than Medical Imaging Technology

"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 reported online in December 18, 2009, in the Journal of Neurosurgery.

Patients typically receive CT scans following open brain surgery to remove tumors, repair aneurysms, and treat brain injuries. But practices vary: Some surgeons order CT scans immediately after surgery, others wait until the following morning. However, there are downsides: CT scans cost hundreds of dollars and expose patients to radiation, and transporting patients to scanning machines, "involves multiple personnel of varying skills and nursing staff who are taken away from their other unit responsibilities,” the researchers reported. "These scans also often interfere with work flow efficiencies of the radiology department.”

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 (Maywood, IL, USA). The senior author is Dr. Thomas Origitano, chairman of the department of neurological surgery. The 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 neurologic 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%) 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.

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 neurologic 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 slight problems.

"Scanning technology is really good,” Dr. Origitano said. "But applying it without a physician's input is not necessarily helpful.”

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Loyola University Chicago Stritch School of Medicine