Author Affiliations: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Dr Hoffman); and Department of Medicine/Emergency Medicine, University of California, Los Angeles (UCLA), School of Medicine (Drs Hoffman and Cooper).
Most of us learned that brain herniation is about as close to death as a living patient can get. But a clinically important proportion of patients with head computed tomography (CT)-defined herniation are awake and alert (personal communication, Kelli O’Laughlin, MD, MPH, December 1, 2011).1,2 Is herniation far less grave than we have always thought? Does this mean that we need to order even more CT scans so as not to miss “occult” herniation in normal-appearing patients?
Hoffman JR, Cooper RJ. Overdiagnosis of DiseaseA Modern Epidemic. Arch Intern Med. 2012;172(15):1123-1124. doi:10.1001/archinternmed.2012.3319