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To the Editor.—
Fineberg and his associates (238:224-227,1977) consider 19% an upper limit estimate of the marginal contribution of computerized cranial tomography (CCT) to changes in therapeutic plans during routine clinical practice at a teaching hospital. I agree with the authors' contention that utilization guidelines are important in assessing efficacy of diagnostic and therapeutic plans. However, their observations on patients at the Massachusetts General Hospital during a 17-day period provide a very limited view of the possible applications of CCT to patient care. The patients referred for CCT came mostly from neurologists who possessed an impressive accuracy of diagnostic judgement prior to CCT. "The physician already knew the diagnosis with 100% certainty in fully one third of those patients whose therapy was altered in some say following CCT."To truly appreciate the value of CCT, one needs to share a moment of decision with a practitioner in a hospital that
Feldman RG. Computerized Cranial Tomography. JAMA. 1977;238(22):2367–2368. doi:10.1001/jama.1977.03280230031012
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