I just want to take time in this post for some “housekeeping” and touch very quickly on 2 subjects that have been fairly regular features of this blog.
#1 is the use and overuse of CT scanning, especially in the ED. A recent study from the Netherlands Cancer Institute reinforced earlier information I had presented regarding cancer risk from the large radiation doses in CT scans. I support the thoughtful statement of the authors who say:
“CT scans for children represent a potentially life-saving and quality of life-improving technique for many patients. In addition, the tumors evaluated here are associated with small absolute excess risks. Nonetheless, careful justification of pediatric CT scans and dose optimization, as are customary in many hospitals, are essential to minimize risks.”
Specifically, I have spoken of the use of CT at the ED in evaluating for possible appendicitis. This month’s American Family Physician includes an article about that subject, which diagrams the evaluation process from an article by Dr. G Santilles from Academy of Emergency Medicine in 2012. For negative CT, the authors say, possible discharge with follow up in 6-12 hours is appropriate. In other words, if that person is sick enough to need a CT at that time then they are sick enough to need to be seen and re-evaluated in less than 24 hours. Ideally, the ED doctor should call and speak directly to the primary care doctor to insure proper “hand off” of these cases, I believe. This is of particular concern for weekend incidents when office hours may be more limited. So, my advise? If you are in this situation with your child, do not hesitate to request that the ED doc call your primary care to “touch base.” It’s the right thing to do. Safety first. And BE SURE to be seen next day.
The other subject is the overuse of antibiotics. Another recent study found that urgent care center visits for respiratory illness result in prescriptions for antibiotics in 40% of cases. However, careful scientific analysis shows that bacteria are actually responsible for perhaps 5% of these illnesses. The rest are viral; the antibiotics are unnecessary, unhelpful, and not infrequently can themselves cause harm. Now, I understand the convenience of these urgent care centers; not too small an issue for busy parents. However we should keep in mind the old consumer adage that “you get what you pay for” and this data shows pretty clearly that, in too many instances, the advantage of convenience comes at the cost of a lot of over treatment and not useful medicines. So, again,–my advise? If at all possible, wait for your doctor’s office to be open the next day. Doing it right is almost always better than doing it fast.
For a review of the risks of antibiotic misuse please check here.
Thanks for following.