This is why assessments like this one are controversial. They’re easy to abuse. Especially when they become an excuses to judge, mock or under treat the patient.

I stand by the idea that it remains a valid clinical assessment and yields useful information. Applying stimulus and assessing response is a foundation of neurologic assessment. Even in the case of the hand drop where the results are not only informative but also occasionally amusing.

EMT – I’m not sure if you’re contradicting yourself but I do diagree with your premiss. In your first post you’re upset at responders for not having a high enough index of suspicion on unresponsive patients (and I think your using this test as the scape goat for poor care.) In the second post you imply that the information gathered by the test is invalid or useless if we chose to still treat the patient in a medically appropriate way.

We gather information. We develop an impression about what is probably occuring with our patient and we consider other possibilities as well … always accounting for the worst case scenario.

Complete, detailed assessment isn’t an excuse to under treat. But complete treatment isn’t an excuse to under evaluate either.

I think we diminish the significance of the possible underlying mental health emergency by being suspicious and judgmental about the patient’s choice to not respond to stimulus.

While assessing AVPU and determining the cause of VPU is important we best make sure our assessments are aimed at helping the patient and not judging the patient.

I mean, the hand either hits their face or not. If it doesn’t, I don’t know of anyone who uses it who would say “Ok, it didn’t hit, which is supposed to mean they’re faking, but I’ll treat them like it DID hit.” If you’re going to do that there’s no point to performing the test.

Oh wait.

I disagree that the hand drop evaluation is “ridiculous”. Like all diagnostic tests it is only as good as the clinician using it. Thanks for your input.