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The objective of this study was to compare through questionnaires the test-ordering behavior of college health professionals and emergency physicians with respect to the choosing of computed tomography scans under two clinical scenarios-suspicion of appendicitis and nondescript abdominal pain. Surveys were sent to physician members of both the American College Health Association and the American College of Emergency Physicians. The recipients were asked if their initial workup would include a computed tomography (CT) scan for either clinical scenario. They were queried on their estimation of the importance of physical examination findings, practice standards, economic considerations, and interpersonal factors on the decision to obtain a CT. They were also asked if their decision to order a CT was related to physical exam findings, parental influence, established protocol, costs to student, insurance considerations, medical literature recommendations, and relationship with radiologist. For the first presentation, a clinical suspicion of appendicitis, there was little difference between the choices of the two groups. Seventy seven percent of the college health professionals would obtain one and 76% of the ER physicians would do the same. However, for the workup of nondescript pain, three times as many ER physicians as college health professionals would obtain a CT scan (34% vs 11%). Of the seven factors, the most important determinant for both groups of physicians was the results of physical exam and least important by far was the relationship to the radiologist. [ABSTRACT FROM AUTHOR]

We report an unusual manifestation of penetrating facial trauma. It was suffered by a recreational fly fisherman who was hiking away from a casting spot when he fell and was impaled by a section of his graphite flyrod. The circumstances of his injury, its clinical manifestations, and its imaging findings are discussed. Emergency physicians and radiologists should be aware of the computed tomography appearance of impaled foreign bodies and their capability to penetrate deeply to reach critical vascular and neurologic structures. The role of imaging in penetrating trauma to the face and skull base for guiding appropriate intervention is emphasized. [ABSTRACT FROM AUTHOR]