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(NPR)   New article in Pediatrics finally speaks the plain truth: Look, moron, your snowflake doesn't need a CT scan every time he bumps his head   (npr.org) divider line 126
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4969 clicks; posted to Main » on 10 May 2011 at 12:34 PM (3 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2011-05-10 12:36:06 PM
And we wonder why our healthcare costs are so high.....
 
2011-05-10 12:36:42 PM
Tell that to the sue happy attorneys
 
2011-05-10 12:38:50 PM
This and that.

/End thread.
 
2011-05-10 12:38:56 PM
I took a nasty tumble on a field trip in the 2nd or 3rd grade. We were all hanging out on our lunch break and climbing these statutes. Slipped and landed flat on my back on the concrete below, banged my head pretty bad.

Parents called the doc who just told them to keep me up and about and make sure I didn't seem strange. No CT scan for me, but I did get some chocolate cake.

/CSB
//Yeah, I blacked out for a second or two after I hit the ground, probably should have been scanned...
 
2011-05-10 12:39:11 PM
Unless it is a really big bump, just keep the kid at home and if he does not become nauseous in a few hours he will be fine.
 
2011-05-10 12:39:22 PM
Not to mention the radiation dose received from a CT scan. This could also lead to higher rates of cancer in children. Sure, 150 mrem may not be that much, but it's still higher than just receiving background.
 
2011-05-10 12:39:51 PM
FTDA: "But good luck getting your local emergency room to back off of them. "

I have a surefire way of making this happen: don't take your snowflake to the ER for a head bump unless he's unconscious. Every kid bumps his head. Moms and dads used to know to keep an eye on junior for signs of a concussion. They didn't get too excited. But then parents used to have too much to do to be helicopters. Now junior gets whisked to a doctor at the first sign of snot in his nose.
 
2011-05-10 12:40:24 PM
My wifes job is to panic when the kids get hurt.

My job is pull her back into reality, reassure her everything is ok, and keep her from taking the kids to the ER at ther drop of a hat.
 
2011-05-10 12:40:27 PM
stupid headline- you really think its the parents demanding this and not the doctors and ER's doing it to pay for the VERY expensive CT equipment?
 
2011-05-10 12:41:19 PM
After you throw up, you're usually fine. If you pass out, you probably have a concussion.
 
2011-05-10 12:42:06 PM

tlchwi02: stupid headline- you really think its the parents demanding this and not the doctors and ER's doing it to pay for the VERY expensive CT equipment?


How about not giving them the chance by eliminating the weekly ER runs...
 
2011-05-10 12:43:04 PM
I think you are better safe than sorry. When I was a kid, my older brother climbed up on top of the swing-set and stood on the cross bar. He was screwing around, lost his balance, fell and hit his head on the concrete anchor. He was bleeding like crazy, completely confused, and vomiting. But my mom said, "Oh, head injuries always bleed a lot. He's fine." She stopped the bleeding, but I really think the wound should've been stitched up because you could see his skull under the torn flap. Neosporin isn't fixing that overnight.

Before the accident, he was a really bright, friendly, funny kid. Afterward, though, he was really moody and aggressive. He spent most of his time sitting on the front porch reading the bible out loud, or whittling sticks into sharp points. He got in trouble at school, started stealing stuff, just ruined himself.

Three years ago he was robbing a convenience store, and for no apparent reason, stabbed the clerk in the back with a twelve inch hunting knife. He's in prison now, death row, yet he still continually gets in trouble -- rape, violence against the guards, rape, refusing to eat.

So, if you have any doubt that your kid might need a head scan, I'd just do it. It might save his life.
 
PJ-
2011-05-10 12:45:20 PM
So when do mandatory safety helmets come into effect? You know, where children up to the age of 6 have to wear a helmet at all times.
 
2011-05-10 12:45:46 PM
Subby fails with the "special snowflake" line:

And the scans also don't catch minor injuries any better than observing the child, according to a new study in the latest issue of Pediatrics. But good luck getting your local emergency room to back off of them.

...and...

Just 14 percent of the doctors in the study observed children's symptoms first, Nigrovic found. And they didn't miss injuries any more often than did the docs who scanned first.

Parents aren't ordering these tests; doctors are. Most parents won't have the knowledge to school a doctor on whether or not the scan is necessary, so they just sign off on it.
 
2011-05-10 12:48:23 PM
FTFA: "But good luck getting your local emergency room to back off of them. "

As someone who works in a hospital, the issue is usually the over protective parents demanding xrays and CT scans for every little thing, not the doctor ordering them. For alot of these parents "just make sure to keep him/her awake for 5 hours" isn't enough, the doctors don't want to send them in case there's a real emergency.
 
2011-05-10 12:48:56 PM

spentmiles: I think you are better safe than sorry. When I was a kid, my older brother climbed up on top of the swing-set and stood on the cross bar. He was screwing around, lost his balance, fell and hit his head on the concrete anchor. He was bleeding like crazy, completely confused, and vomiting. But my mom said, "Oh, head injuries always bleed a lot. He's fine." She stopped the bleeding, but I really think the wound should've been stitched up because you could see his skull under the torn flap. Neosporin isn't fixing that overnight.

Before the accident, he was a really bright, friendly, funny kid. Afterward, though, he was really moody and aggressive. He spent most of his time sitting on the front porch reading the bible out loud, or whittling sticks into sharp points. He got in trouble at school, started stealing stuff, just ruined himself.

Three years ago he was robbing a convenience store, and for no apparent reason, stabbed the clerk in the back with a twelve inch hunting knife. He's in prison now, death row, yet he still continually gets in trouble -- rape, violence against the guards, rape, refusing to eat.

So, if you have any doubt that your kid might need a head scan, I'd just do it. It might save his life.


Sounds like Phineas Gage. Yeah, I think if your kid's skull is showing, a doctor's visit is justified. But doctors do like to play up the CT scans because it is profitable.
 
2011-05-10 12:49:46 PM
Lawyers' first question "did they do a CT scan in the emergency room?"

Every hospital and doctor knows this and that's why they are done.
 
2011-05-10 12:51:47 PM

maskedloser: S
Parents aren't ordering these tests; doctors are. Most parents won't have the knowledge to school a doctor on whether or not the scan is necessary, so they just sign off on it.


Came here to say that. ED (ER) docs to stop ordering them. They will cave into parents, too.

I work in Teleradiology, and make money off reads, and I would encourage you NOT to pressure an ED doc into ordering anything YOU want.
 
PJ-
2011-05-10 12:52:02 PM

skybreaker: FTFA: "But good luck getting your local emergency room to back off of them. "

As someone who works in a hospital, the issue is usually the over protective parents demanding xrays and CT scans for every little thing, not the doctor ordering them. For alot of these parents "just make sure to keep him/her awake for 5 hours" isn't enough, the doctors don't want to send them in case there's a real emergency.


Yes, because you know how every other hospital in the country works right? Tell me, what is the protocol for a Colorado hospital that is interviewing a 4 year old kid that doesn't remember his birthday or last night, has a bloody nose, and the parent says 'i'm not entirely sure what happened, I was in the kitchen for a couple minutes, and heard a huge thud and he was crying saying he hit his head'.
 
2011-05-10 12:52:31 PM

Seacop: How about not giving them the chance by eliminating the weekly ER runs...


The article says absolutely nothing about whether parents are taking kids to the ER 'too much' or not.

As spentmiles points out, there are some times when a kid should go to the ER but isn't taken. Parental negligence of that sort is the polar opposite of 'special snowflakism,' and probably just about as common.
 
2011-05-10 12:54:05 PM
Seems like a waste if the test doesn't help in diagnosing a concussion.

I wonder how much this test *really* costs. In the US, ERs charge $10 for a bandaid because they have to overcharge patients with insurance to make up for the losses they incur caring for the uninsured. How much does a CT scan cost the UK's NHS?
 
2011-05-10 12:54:34 PM

spentmiles: So, if you have any doubt that your kid might need a head scan, I'd just do it. It might save his life.


You've been doing some pretty good work around here the last few days.
 
2011-05-10 12:54:51 PM

spentmiles: So, if you have any doubt that your kid might need a head scan, I'd just do it. It might save his life.


Dude... stop talking about me on the internet. When I get my phone call next week, I'm telling mom.
 
2011-05-10 12:54:52 PM
Most ER tests are done to avoid liability. They call it defensive medicine downstairs. Keep the lawyers under control and healthcare costs will come down.
 
2011-05-10 12:55:06 PM

Infobahn: maskedloser: S
Parents aren't ordering these tests; doctors are. Most parents won't have the knowledge to school a doctor on whether or not the scan is necessary, so they just sign off on it.

Came here to say that. ED (ER) docs to stop ordering them. They will cave into parents, too.

I work in Teleradiology, and make money off reads, and I would encourage you NOT to pressure an ED doc into ordering anything YOU want.


Here's what the researcher suggested as an antidote:

She's hoping both doctors and parents will be hip to the fact that CTs aren't always required, particularly since they can't diagnose concussion, a common head injury in children. "If you can explain that you will observe their child in the ER and try to avoid a potentially dangerous scan, they're on board with that," she says of the parents she sees in the ED.
 
2011-05-10 12:58:04 PM

PJ-: skybreaker: FTFA: "But good luck getting your local emergency room to back off of them. "

As someone who works in a hospital, the issue is usually the over protective parents demanding xrays and CT scans for every little thing, not the doctor ordering them. For alot of these parents "just make sure to keep him/her awake for 5 hours" isn't enough, the doctors don't want to send them in case there's a real emergency.

Yes, because you know how every other hospital in the country works right? Tell me, what is the protocol for a Colorado hospital that is interviewing a 4 year old kid that doesn't remember his birthday or last night, has a bloody nose, and the parent says 'i'm not entirely sure what happened, I was in the kitchen for a couple minutes, and heard a huge thud and he was crying saying he hit his head'.


If there's any kind of memory loss or obvious symptoms that's a different issue. I'm just speaking of over protective parent who runs to a doctor for every scrape/cut/bruise, or instances where a kid shows no symptoms.
 
2011-05-10 12:58:58 PM

spentmiles: I think you are better safe than sorry. When I was a kid, my older brother climbed up on top of the swing-set and stood on the cross bar. He was screwing around, lost his balance, fell and hit his head on the concrete anchor. He was bleeding like crazy, completely confused, and vomiting. But my mom said, "Oh, head injuries always bleed a lot. He's fine." She stopped the bleeding, but I really think the wound should've been stitched up because you could see his skull under the torn flap. Neosporin isn't fixing that overnight.

Before the accident, he was a really bright, friendly, funny kid. Afterward, though, he was really moody and aggressive. He spent most of his time sitting on the front porch reading the bible out loud, or whittling sticks into sharp points. He got in trouble at school, started stealing stuff, just ruined himself.

Three years ago he was robbing a convenience store, and for no apparent reason, stabbed the clerk in the back with a twelve inch hunting knife. He's in prison now, death row, yet he still continually gets in trouble -- rape, violence against the guards, rape, refusing to eat.

So, if you have any doubt that your kid might need a head scan, I'd just do it. It might save his life.


10/10. two bites already!

/you said rape twice. do you like rape?
 
2011-05-10 12:59:15 PM

maskedloser: Seacop: How about not giving them the chance by eliminating the weekly ER runs...

The article says absolutely nothing about whether parents are taking kids to the ER 'too much' or not.

As spentmiles points out, there are some times when a kid should go to the ER but isn't taken. Parental negligence of that sort is the polar opposite of 'special snowflakism,' and probably just about as common.


oh jesus christ.
 
2011-05-10 01:00:33 PM
Ra-di-a-tion. Yes, indeed. You hear the most outrageous lies about it. Half-baked goggle-box do-gooders telling everybody it's bad for you. Pernicious nonsense. Everybody could stand a hundred CT scans a year. They ought to have them, too.

/oblig.
 
2011-05-10 01:03:58 PM

Seacop: maskedloser: Seacop: How about not giving them the chance by eliminating the weekly ER runs...

The article says absolutely nothing about whether parents are taking kids to the ER 'too much' or not.

As spentmiles points out, there are some times when a kid should go to the ER but isn't taken. Parental negligence of that sort is the polar opposite of 'special snowflakism,' and probably just about as common.

oh jesus christ.


He might be trollin', it turns out, but he's also right.
 
2011-05-10 01:04:27 PM
The study is probably correct, but I am very happy some doctors still order the CT scans, just in case. My child hit her head last year and got a CT in the ER, and they found a brain tumor before she showed symptoms.
 
2011-05-10 01:04:44 PM
I'm sorry I am not aware of all internet traditions.
 
2011-05-10 01:06:45 PM

ramblinwreck: Not to mention the radiation dose received from a CT scan. This could also lead to higher rates of cancer in children. Sure, 150 mrem may not be that much, but it's still higher than just receiving background.


I teach a course in radiation principles. Over the past decade or so, the average, non-occupational dose has risen from 360 to 620 mrem/year. Why? Nuclear/radiological medicine primarily (link, link). My lesson plan cites a CT scan at 1100 mrem each... though it was a health physicist that researched and wrote that section so I don't have that reference.

Either way, medical culture has shifted to accept lots of dose for lots of patients. Think of all the people you know that haven't gotten a CT scan or nuclear medicine treatments in the last three years, and then think of what that means to the person bumping up that average!
 
2011-05-10 01:08:50 PM
I swear some people would demand X-rays if their kid split a nail
 
2011-05-10 01:08:56 PM

metaomni: I took a nasty tumble on a field trip in the 2nd or 3rd grade. We were all hanging out on our lunch break and climbing these statutes. Slipped and landed flat on my back on the concrete below, banged my head pretty bad.

Parents called the doc who just told them to keep me up and about and make sure I didn't seem strange. No CT scan for me, but I did get some chocolate cake.

/CSB
//Yeah, I blacked out for a second or two after I hit the ground, probably should have been scanned...



I had something similar happen when I was in grade 4 during winter; slipped on some ice and bounced my head off of it. My vision went completely white, my hands and face went numb. Since then I get migraines when I get too hot that cause my vision to go pure white like I've been staring at the sun too long, takes about five minutes to go from fine to OMFG I'M BLIND!!1!eleventy! I also don't recognize my own left hand... it's like when someone opens a door in POV during a movie, you recognize that it's supposed to be your hand but it's clearly not. I used to be great at math and after the accident I had trouble with simple calculations of any type.
I was told to stay up and not take anything for it. Got to drink pop and watch any movies I wanted with the next day off school.

Definitely should have gotten a head CT.

On a good note, megadoses of B2 lessen the severity of the migraines, and how often I get them.

/CSB
 
2011-05-10 01:10:52 PM

Infobahn:
I work in Teleradiology, and make money off reads, and I would encourage you NOT to pressure an ED doc into ordering anything YOU want.


I didn't realize that Erectile Dysfunction docs had to scan your pecker!
 
2011-05-10 01:11:13 PM
Oh, found a link on the CT scan dosage (new window), and the source seems reliable. 200-400 mrem for the head, with the highest-dose region being 1500-3000 mrem for the abdomen and pelvis.
 
2011-05-10 01:12:21 PM
not all head injuries produce symptoms. cf asymptomatic tbi.
a normal ct does not mean the brain has not been injured.

ct and observation should not be exclusive clinical considerations.
 
2011-05-10 01:13:01 PM

factoryconnection: ramblinwreck: Not to mention the radiation dose received from a CT scan. This could also lead to higher rates of cancer in children. Sure, 150 mrem may not be that much, but it's still higher than just receiving background.

I teach a course in radiation principles. Over the past decade or so, the average, non-occupational dose has risen from 360 to 620 mrem/year. Why? Nuclear/radiological medicine primarily (link, link). My lesson plan cites a CT scan at 1100 mrem each... though it was a health physicist that researched and wrote that section so I don't have that reference.

Either way, medical culture has shifted to accept lots of dose for lots of patients. Think of all the people you know that haven't gotten a CT scan or nuclear medicine treatments in the last three years, and then think of what that means to the person bumping up that average!


I thought that ~1100 mrem was for abdomen or other large scans vs the small size of a child's head. Is ~1100 an average for all documented CT scans?
 
2011-05-10 01:13:02 PM

Barakku: I swear some people would demand X-rays if their kid split a nail


my favorite i've seen is a parent demanding an MRI on a bruise on their kids calf because according to the parent "I know a torn ligament when i see one!"
 
2011-05-10 01:14:07 PM
I'm a total klutz and was naturally an accident prone child, but I never had to go to the emergency room. Yes, I (and my little sister) frequently hit our head on things, but my parents were smart enough to teach themselves the danger signs. And then they made sure we knew them too.

...Which is probably why I weirded out my riding instructor after my horse bolted out from under me and I hit the ground hard. Class runs to me to make sure I'm all right and all I do is point to my face "Are my pupils the same size?" "Uhm, yes." "Good, help me up." My vision had whited out on my head's impact, but I hadn't blacked out so with the pupil check, my checklist was done.
/CSB


Pupils uneven, loss of consciousness (no matter how short), vomiting, disorientation - all reasons to take someone to the ER after a head bump. Also if they didn't have any of those signs to start with but the headache is not going away the next day. Otherwise, hand your kid an ice pack and tell them to suck it up.



/yes, I was wearing a helmet while riding, I'm not stupid
//was also very grateful I still had percoset left from my dental surgery a few weeks before the accident.
 
2011-05-10 01:14:20 PM
Both the test the kids and dont test the kids people mak valid points. Clearly a decision has to be made. The doctors as has been pointed out have a financial interest in seeing the test done. It has to be up to the patient or parent.

You know the the thought process goes something like this:

Do I have to pay for the test myself? Yes/No

The answer is no if the patient/parent:
1. has single payer healthcare.
2. has great insurance.
3. is poor and plans to say 'fark you' when the bill comes.
4. is filthy stinking rich and dont care.

The answer is yes if the patient/parent:
2. has an HSA or other high deductible policy.

If the answer is NO the the patient/parent says 'Fark yea I want the test! And I want it now. And if I don get Ima sue every one of you! Cant you see my snowflake is hurt!'

If the answer is yes then the answer is 'how much is the test?'. Followed by 'Do I really need it?'

This question has no right answer. Just some answers that are mostly better than others.
 
2011-05-10 01:17:50 PM

pdee: Both the test the kids and dont test the kids people mak valid points. Clearly a decision has to be made. The doctors as has been pointed out have a financial interest in seeing the test done. It has to be up to the patient or parent.



ER doctors have no personally financial interest in seeing the test get done. They're salaried by the hospital and aren't paid per patient/test.
 
PJ-
2011-05-10 01:17:57 PM

skybreaker: PJ-: skybreaker: FTFA: "But good luck getting your local emergency room to back off of them. "

As someone who works in a hospital, the issue is usually the over protective parents demanding xrays and CT scans for every little thing, not the doctor ordering them. For alot of these parents "just make sure to keep him/her awake for 5 hours" isn't enough, the doctors don't want to send them in case there's a real emergency.

Yes, because you know how every other hospital in the country works right? Tell me, what is the protocol for a Colorado hospital that is interviewing a 4 year old kid that doesn't remember his birthday or last night, has a bloody nose, and the parent says 'i'm not entirely sure what happened, I was in the kitchen for a couple minutes, and heard a huge thud and he was crying saying he hit his head'.

If there's any kind of memory loss or obvious symptoms that's a different issue. I'm just speaking of over protective parent who runs to a doctor for every scrape/cut/bruise, or instances where a kid shows no symptoms.


That's the problem though, how many 4 year olds know their first and last name perfectly? How many 4 year olds would be able to answer a complete stranger a question in when their date of birth is? According to the doctor, there is memory loss, but it can't be decided if it's just a 4 year old who hasn't completely learned his last name, or birthday (actual date), or if it's damage to the brain.

I'll agree, that some parents are way to sensitive to such things, but the problem is, it puts the doctor in a tough spot. So rather than do what is thought to be best, the doctor has to cover his own ass. I personally think it's up to the doctor to convince the parents that a CT scan isn't needed, not just say 'not needed'. Educate the parents in how the doctor made the decision, use common words, not just medical speak that will only confuse the parent. Also explain the risks that there are to the child by going through the procedure, not just the radiation, but the emotional stress. For a small child, a simple thing like a CT scan can be extremely stressful, and lead to an extreme fear of doctors/hospitals. I was terrified of my family doctor after going through a few simple tests when I had pneumonia at the age of 8.
 
2011-05-10 01:18:05 PM
I got whacked in the head so hard with a baseball bat when I was about 10 that I was knocked out (was standing too close to the guy batting, duh). The adults gave me some ice and told me not to stand so farking close next time.

I lived, but I became a alcoholic. Parents, let this be a lesson to you.

And spentmiles, GTFO of here. I start getting all teared up, then I see your name.
 
PJ-
2011-05-10 01:22:49 PM

skybreaker: pdee: Both the test the kids and dont test the kids people mak valid points. Clearly a decision has to be made. The doctors as has been pointed out have a financial interest in seeing the test done. It has to be up to the patient or parent.


ER doctors have no personally financial interest in seeing the test get done. They're salaried by the hospital and aren't paid per patient/test.


Nope, but they receive bonuses based on different procedures and questions asked. 'Do you smoke?' Most hospitals will give a doctor a few bucks just for asking that question. Why? Because the doctor took time out of their day to educate the patient about not smoking. They also get money for referring patients to other departments in the hospital.
 
2011-05-10 01:23:12 PM

tlchwi02: stupid headline- you really think its the parents demanding this and not the doctors and ER's doing it to pay for the VERY expensive CT equipment?


Stupid comment. Of COURSE the parents want a CT scan. That's why they brought Junior to the EMERGENCY ROOM.

If they just took him to their pediatrician, he/she could explain why a CT scan for a head boink is a stupid and expensive bit of overkill. ER docs, OTOH, are trained and encultured in going for the scattergun approach to treating patients, especially kids. And they're overworked; it's easier to just do the damned CT than it is to take the time to explain why it's not necessary. (Not saying that's the right approach, just 'splainin'.)

/You wouldn't believe the number of times I've had to talk Mr. and Mrs. Sikorsky out of expensive imaging studies.
 
2011-05-10 01:24:06 PM

superdude72: In the US, ERs charge $10 for a bandaid because they have to overcharge patients with insurance to make up for the losses they incur caring for the uninsured.


You kinda have this backwards. People with insurance get negotiated rates, usually less than half. The uninsured get the full cost buttfark rates. No, not all of them can pay, but those that don't get their credit ruined and sometimes have to declare bankruptcy. I've known a couple of people sans insurance who got admitted for heart attack, broken leg, etc. and basically they spent a few years paying it off. One day in the hospital was like buying a car.

This is part of the reason we've desperately needed health care reform, and the republicans want it blown up they hate it so much.
 
2011-05-10 01:26:36 PM

PJ-: skybreaker: pdee: Both the test the kids and dont test the kids people mak valid points. Clearly a decision has to be made. The doctors as has been pointed out have a financial interest in seeing the test done. It has to be up to the patient or parent.


ER doctors have no personally financial interest in seeing the test get done. They're salaried by the hospital and aren't paid per patient/test.

Nope, but they receive bonuses based on different procedures and questions asked. 'Do you smoke?' Most hospitals will give a doctor a few bucks just for asking that question. Why? Because the doctor took time out of their day to educate the patient about not smoking. They also get money for referring patients to other departments in the hospital.


Maybe in a private hospital, that doesn't happen in health ministries.
 
2011-05-10 01:28:04 PM
The ER docs who order the tests don't get any money for them. They may get less annoyance from insistent parents. They may have less liability. But this is not being driven by reimbursement.
 
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