Doctor's Skill Can Trump Technology

(December 20, 2009) - You can have, and use, all the technology in the world, but sometimes it just can't beat the skills of a doctor, according to a new study. Researchers found that physicians' bedside exams did a better job than CT scans (Read about "CT Scan - Computerized Tomography") in predicting which patients would need to return to the operating room to treat complications, such as bleeding, after brain surgery. (Read about "Neurosurgery")

"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 report in the Journal of Neurosurgery.

According to the study, patients typically receive CT scans following open brain surgery to remove tumors, repair aneurysms, treat brain injuries, etc. (Read about "Brain Tumors" "Aneurysms" "Head Injury") But practices vary. Some surgeons order CT scans right after surgery. Others wait until the following morning.

Researchers examined the records of 251 patients who received CT scans within 24 hours of surgery. 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 neurological 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 percent) confirmed the patients' problems were serious enough to require a return to the operating room. By comparison, 0 percent of the 241 routine CT scans predicted whether patients would have to return to the emergency room. (Read about "Emergency Room")

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 minor problems.

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