Article

Interobserver agreement in computer tomography readings for pulmonary embolism

Correspondence 119

section helical CT versus selective pulmonary arteriography in 157 patients. Radiology 2000;217:447-55.

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Interobserver agreement in computer tomography readings for pulmonary embolism

To the Editor,

We would like to thank the authors for the positive comments to our work. Moreover, we appreciated very much the additional data they cited that are of help in completing our study. Therefore, we agreed with all the points raised, and we hope that further studies on a larger scale may verify the utility of a second “expert” radiologic opinion in the cases of nonmassive pulmonary embolism.

Giorgio Costantino MD Anna Maria Rusconi MD Nicola Montano MD

Medicina II. Ospedale L. Sacco Universita degli Studi di Milano, Milan, Italy

doi:10.1016/j.ajem.2010.08.015

Letter to “Management of Motorcycle accident-related blunt Hepatic injury–a different strategy”

To the Editor,

Lin et al [1] reported a different strategy to management of motorcycle accident-related blunt hepatic injury. They concluded that patients with stable hemodynamics may be observed safely on an ordinary ward rather than in the intensive care unit, especially those with lower grade blunt hepatic injury. In addition, they also found that motorcyclists

are also prone to have other Associated injuries, which make their injury severity score higher than other mechanisms of injuries. However, patients with higher injury severity score may need to be observed in the intensive care unit rather than the ordinary ward. I argue that favorable results of their patients may be due to exclusion of more severely injured patients, including those died in the ED, had been transferred to other facilities, or had other types of trauma requiring surgery. Nevertheless, I would like to know, if the patient does not receive angioembolization, will the rebleeding rate increase? Besides, is the grade of laceration associated with speed during collision in their patients? This is an interesting article, and I am looking forward to their reply.

Jiun-Nong Lin MD Department of Emergency Medicine E-Da Hospital/I-Shou University Kaohsiung County 824, Taiwan

E-mail address: [email protected] doi:10.1016/j.ajem.2010.09.002

Reference

  1. Lin HL, Lee KT, Chen CW, et al. Management of motorcycle accident- related blunt hepatic injury–a different strategy. Am J Emerg Med 2010;28:177-82.

A response to a letter regarding the article “Management of motorcycle accident-related blunt hepatic injury–a different strategy”

To the Editor,

We are grateful that our article, “Management of motorcycle accident-related blunt hepatic injury–a differ- ent strategy” [1] has drawn the attention of your readers and generated some queries, and we would like to comment on the response generated by our original article.

In the letter, the authors disagree with our conclusion that “patients with stable hemodynamics may be observed safely on an ordinary ward rather than in the intensive care unit (ICU), especially those with lower grade blunt hepatic injury patients,” and firstly argue that our favorable results might have come from exclusion of severely injured patients who either died in the ED, had been transferred to other facilities, or had other types of trauma requiring surgery. We would like to emphasize that, as we have mentioned in our article, the reason for a different strategy was the different group of patients we were managing. Although we excluded the above-mentioned patients, there was no effect on the severity of our selected group. The study object in our article was management of blunt hepatic injury of motorcyclists. If patients died from a motorcycle accident in the ED, the exact extent of their injuries

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