PubMed · 5435199
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H A Constable. 1970-02-28. Unnecessary x-rays?. https://doi.org/10.1136/bmj.1.5695.564-b
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OBJECTIVE: To assess practicality, clinical merit and usefulness for scientific purposes of a hand injury chart in a hand surgery unit. DESIGN: Descriptive. SETTING: Academic Hospital Rotterdam-Dijkzigt, the Netherlands. METHODS: The records were examined of patients who within the period of one ear required acute surgical therapy for serious hand injuries (n = 148). Data concerning cause and extent of the damage to anatomical structures were recorded to evaluate accuracy in describing a hand injury with and without the chart. Time needed to study the patient record to ascertain sufficient details of the injury was noted in each case. RESULTS: The accuracy in describing a hand injury increased significantly for all anatomical structures except vascular lesions in patient records containing the hand injury chart compared with records without the chart. Using the chart saved one minute of time at the first aid station and the outpatient department. CONCLUSION: The use of a hand injury chart allowed a more accurate and uniform description. The computerized data could be easily used for scientific and audit purposes.
In the present study medical departments at 57 (83%) of all hospitals in Norway answered a questionnaire about the criteria used to diagnose acute myocardial infarction. One hospital specified a period of chest pain lasting over 30 minutes; 14 hospitals worked on 30 minutes and 36 hospitals based their diagnosis on a period of less than 30 minutes. Six hospitals did not use any particular duration of pain in order to make a positive diagnosis. There were no important differences over the electrocardiogram criteria. Information on the type of enzymes used for diagnosis, enzyme combinations, and threshold values of the different enzymes, did reveal inequalities between the hospitals. In the 46 hospitals using creatine kinase (CK) the threshold for a positive diagnosis varied between 170 and 500 IE/1 for men and 150 and 400 IE/I for women. For aspartate dehydrogenase (ASAT) the variation was between 40 and 100 and 35 and 75 IE/I for men and women respectively. Unequal criteria for the diagnosis of acute myocardial infarction may lead to differences in treatment, variations in the assessment made by the health insurance scheme and could complicate follow-up studies of this disease.