David Newman returns for Part 3 in this series on Diagnostic Testing. The "likelyhood ratio" is discussed. How does the negative CT effect your ordering of LP in those patients with high risk headaches who might have SAH.
To view chapter written summaries, you need to subscribe.
In tandem with Dr. Hoffmans concerns, we submitted a rapid response to the BMJ and also wrote the authors regarding weaknesses in the claims made in the BMJ article of CT in diagnosis of SAH - but haven't gotten a response. (http://www.bmj.com/rapid-response/2011/11/03/re-sensitivity-computed-tomography-performed-within-six-hours-onset-headac). Mainly, concerns about the legitimacy of the "specificity" claim when there appeared to be no attempts made to identify false positives and the utility of LP cannot at all be determined as all patients didn't receive one and which one did or didn't is entirely unclear from the article. We did feel that sensitivity and NPV was the more accurate estimate from the study, and also more important in EM, but perhaps felt even bit alarmed by how "poorly sensitive" it is after 6 hours.
Any suggestions on how one could get access to the Rational Clinical Exam series that he is referring to at the end of the lecture from Annals of Emergency Medicine? I have gone on the website and searched for it and it doesn't seem to be there. I have also tried going on the JAMA website to get more info on their series but cannot find it there either. Maybe my only hope is to go to a medical library and look at the old issues.
Cynthia B. - March 6, 2012 2:51 PM
In tandem with Dr. Hoffmans concerns, we submitted a rapid response to the BMJ and also wrote the authors regarding weaknesses in the claims made in the BMJ article of CT in diagnosis of SAH - but haven't gotten a response. (http://www.bmj.com/rapid-response/2011/11/03/re-sensitivity-computed-tomography-performed-within-six-hours-onset-headac). Mainly, concerns about the legitimacy of the "specificity" claim when there appeared to be no attempts made to identify false positives and the utility of LP cannot at all be determined as all patients didn't receive one and which one did or didn't is entirely unclear from the article. We did feel that sensitivity and NPV was the more accurate estimate from the study, and also more important in EM, but perhaps felt even bit alarmed by how "poorly sensitive" it is after 6 hours.
e c. - March 23, 2012 11:29 AM
Any suggestions on how one could get access to the Rational Clinical Exam series that he is referring to at the end of the lecture from Annals of Emergency Medicine? I have gone on the website and searched for it and it doesn't seem to be there. I have also tried going on the JAMA website to get more info on their series but cannot find it there either. Maybe my only hope is to go to a medical library and look at the old issues.
Bradley E. - March 27, 2012 1:04 PM
http://jama.ama-assn.org/cgi/collection/rational_clinical_exam