delco714 Posted October 22, 2011 Share Posted October 22, 2011 Hey guys, so here's the scoop. For our PA master's thesis, our group wanted to go to SEMPA and do some surveys with the EMPAs. We wanted to know if they have heard of the Canadian CT Head Rules (or any other rules like Nexus II or NOC), if they use the CCHR in practice, or if they ever would. However, our professor shot us down (in flames during presentations) and said it was a worthless venture bc no one uses them here in the states and no one will ever use them (unlike other rules that are heavily utilized like Ottawa Ankle or Nexus C-Spine). It is understandable bc we're dealing with the head and brain here (no room for error!). However for general info, our research review came up with a study that sampled ACEP physicians and around 30% of the small sample (200+) have heard of the CCHR, 12% used them... just food for thought, really.. So basically, our group is now changing our entire project and redoing it from scratch, but I wanted to know... Do you guys know them or use them? What about the Ottawa Ankle Rule? Link to comment Share on other sites More sharing options...
sk732 Posted October 23, 2011 Share Posted October 23, 2011 I think alot of people use it without thinking much about it - well at least I hope they do, because not everyone with a bump on their melon needs their heads looked at in that manner. IMO, it's there formalize that thought process, to triage patients in areas with limited resources, and actually make you use a bit of clinical judgment once in awhile so that patients aren't being turned into glow worms without good reason, much like the other Ottawa Rules are. Of course I work in Canada, so can't do much more than to offer moral support - it does sound to me like your prof is a little closed minded in what you're doing though. SK Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 24, 2011 Moderator Share Posted October 24, 2011 this was my masters thesis paper - no real one single good rule - one's that never miss any scan everyone (whats the point) and one's that scan a reasonable number miss some........ I found it very revealing as a research paper and would think that your program would also - radiation exposure is going to be a HUGE issue as people start getting more cancers due to CT scans.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 24, 2011 Moderator Share Posted October 24, 2011 emergent mri will replace many ct's within a decade. Link to comment Share on other sites More sharing options...
delco714 Posted October 24, 2011 Author Share Posted October 24, 2011 Agree mri is the next big thing... So for the project.. Do you think we should tailor it to how to better it in the eyes of em providers? Like what would you want in a head rule (besides the obvious 100% specificity and sensitivity, as if that was possible). Nexus ii and new orleans faired no better as ventana stated. I'm at a loss now since I was very interested, as was my group. Looks like we'll be doing the ankle rules instead now (blah) bc we are out of time to create something completely novel. Additionally one of our major points was we are interested bc we want to see how this could decrease radiation exposure due to ct (as well as costs and time) And I appreciate the input. Thanks! Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 24, 2011 Moderator Share Posted October 24, 2011 I don't get the logic of the professor - this is a HUGE issue and right now we are basically nuking our patients do death in the future... is a great topic to research to realize their is unseen risks to the things we do.... Link to comment Share on other sites More sharing options...
delco714 Posted October 24, 2011 Author Share Posted October 24, 2011 I truly agree. His main concern is that we won't get any one in our sample that uses any ct rule for head trauma. So, if we don't get anyone that does, then... That's the point, no one uses them? Like I said he doesn't think there's a place for them bc the risk of being wrong... I tried arguing by saying so what? Follow the rules and if your clinical judgement says scan, then scan. But he says then what's the point of rules then? I dunno, it's just all mucky at this point :( Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 24, 2011 Moderator Share Posted October 24, 2011 from personal experience - I don't know the answer to the question even after researching it and writing a 20+ page paper - but I have gained an advanced understanding of how complex the issue is and that has made me a better PA if you are actually trying to find a subset of people using the rules - that might be tough as most the people I worked with would more go on a hunch..... not very scientific indeed - we did have the rules in the laptops and sometimes I would do it just for verification but not an SOP Link to comment Share on other sites More sharing options...
RetNavyPAC Posted October 27, 2011 Share Posted October 27, 2011 Yet another professor who sounds like he's been out of practice for a while. We use the Canadian C-spine Rules (a little better than NEXUS), and Canadian Head CT Rules all the time. I probably cite & explain PECARN criteria to 3-4 sets of parents every Peds ED shift. Link to comment Share on other sites More sharing options...
delco714 Posted October 28, 2011 Author Share Posted October 28, 2011 Very cool! I wont say the name. But he's kind of a big deal in ny and he works full time in EM. glad to see some one so seasoned using them! Link to comment Share on other sites More sharing options...
sk732 Posted November 2, 2011 Share Posted November 2, 2011 I don't get the logic of the professor - this is a HUGE issue and right now we are basically nuking our patients do death in the future... is a great topic to research to realize their is unseen risks to the things we do.... Sort of makes you wonder how much he practices...either that or he's trying to make you really think about how to set your thesis up. SK Link to comment Share on other sites More sharing options...
delco714 Posted November 5, 2011 Author Share Posted November 5, 2011 Just a heads up, we talked to professor again. Officially dropped the thesis and moving on :-\.,*sigh* Thanks for all the input gentlemen! Albeit it still was an interesting discussion Link to comment Share on other sites More sharing options...
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