Evidence-Based Medicine #83: Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules

The ability to differentiate patients who need emergent treatment from those who do not is a vital skill in Emergency Medicine. Solid history-taking, a thorough physical examination, appropriate use of laboratory tests and imaging, and sound clinical judgement are all keys to making these decisions.

However, determining which elements of the patient history, findings on the physical exam, and laboratory and imaging results to use can be challenging for emergency physicians and other providers in acute care settings. Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules will equip you with the information you need to:

• Interpret and draw practical conclusions from published studies
• Understand both bottom-line conclusions and limitations of the various studies on diagnostic testing and clinical decision rules
• Learn how to make the best decision for your patient based on up-to-date evidence

Part I provides an overview of the science of diagnostic testing, reviewing the process behind
the development of clinical decision rules and exploring the increasing pressures to improve the efficiency of diagnostic test utilization faced by emergency practitioners.

Subsequent chapters focus on practical questions that have been addressed through original research studies. The authors provide a review of the current literature on a specific question, an interpretation of the clinical question in the context of the literature (focusing on the actual data behind the studies being referenced) and, finally, how the evidence can be most appropriately applied to the care of emergency patients.

More than ever, you need Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules, a trusted guide to the evidence on diagnostic testing in the emergency setting that will help you make

This book for emergency physicians and fellows training in emergency medicine provides evidence-based information on what diagnostic tests to ask for and when and how to use particular decision rules. The new edition builds on the success of the current book by modifying the presentation of the evidence, increasing the coverage, and updating the current information throughout.

The purpose of this book is to present relevant questions on diagnostic testing that arise in everyday emergency medicine practice and to comment on the best available evidence.

Part I provides an overview of the science of diagnostic testing, reviewing the process behind the development of clinical decision rules and exploring the pressures that, increasingly, emergency practitioners face to improve the efficiency of diagnostic test utilization.

Subsequent chapters focus on practical questions that have been addressed by original research studies. We provide a review of the current literature on a specific question, an interpretation of the clinical question in the context of the literature, and finally how we, as practicing clinicians, apply the evidence to the care of our patients. Importantly, we also try to provide the actual data, sample sizes, and statistics. As readers, you can come to your own conclusions about how to interpret the best available data by understanding not just the bottom line study conclusions, but also the limitations of various study designs.

Evidence-Based Emergency Medicine by Pines; paper; 9781405154000; 1,500 units

Evidence-Based Emergency Medicine by Pines; o-book; 9781444300772; 29 units

Evidence-Based Emergency Medicine by Pines; ebook; 9781444300789; 108 units

Evidence-Based Emergency Medicine by Pines; ePub; 9781444357172; 5 units

Evidence-Based Emergency Medicine by Pines; eMobi; 9781444321715; 82 units

 

About the Authors, xi

Foreword, xv

Preface, xvii

Acknowledgments, xix

Section 1: The Science of Diagnostic Testing and Clinical Decision Rules

1 Diagnostic Testing in Emergency Care, 3

2 Evidence-Based Medicine: The Process, 11

3 The Epidemiology and Statistics of Diagnostic Testing, 19

4 Clinical Decision Rules, 36

5 Appropriate Testing in an Era of Limited Resources: Practice and Policy Considerations, 44

6 Understanding Bias in Diagnostic Research, 54

Section 2: Trauma

7 Cervical Spine Fractures, 67

8 Cervical Spine Fractures in Children, 80

9 Cervical Spine Fractures in Older Adults, 86

10 Blunt Abdominal Trauma, 92

11 Acute Knee Injuries, 97

12 Acute Ankle and Foot Injuries, 102

13 Blunt Head Injury in Children, 107

14 Blunt Head Injury, 117

15 Blunt Chest Trauma, 128

16 Occult Hip Fracture, 135

17 Blunt Soft Tissue Neck Trauma, 141

18 Occult Scaphoid Fractures, 147

19 Penetrating Abdominal Trauma, 153

20 Penetrating Trauma to the Extremities and Vascular Injuries, 162

Section 3: Cardiology

21 Heart Failure, 173

22 Syncope, 181

23 Acute Coronary Syndrome, 189

24 Palpitations, 205

Section 4: Infectious Disease

25 Bacterial Meningitis in Children, 219

26 Serious Bacterial Infections in Children Aged 1–3 Months, 223

27 Necrotizing Fasciitis, 227

28 Infective Endocarditis, 232

29 Pharyngitis, 238

30 Rhinosinusitis, 243

31 Pneumonia, 248

32 Urinary Tract Infection, 255

33 Sepsis, 259

34 Septic Arthritis, 270

35 Osteomyelitis, 278

36 Sexually Transmitted Diseases (STDs), 288

37 Influenza, 295

38 Pediatric Fever in Children Aged 3-36 Months, 303

Section 5: Surgical and Abdominal Complaints

39 Acute, Nonspecific, Nontraumatic Abdominal Pain, 309

40 Small Bowel Obstruction, 317

41 Acute Pancreatitis, 324

42 Acute Appendicitis, 330

43 Acute Cholecystitis, 340

44 Aortic Emergencies, 347

45 Ovarian Torsion, 351

Section 6: Urology

46 Nephrolithiasis, 359

47 Testicular Torsion, 365

Section 7: Neurology

48 Nontraumatic Subarachnoid Hemorrhage, 375

49 Acute Stroke, 381

50 Transient Ischemic Attack, 387

51 Seizure, 394

Section 8: Miscellaneous: Hematology, Ophthalmology, Pulmonology, Rheumatology, and Geriatrics

52 Venous Thromboembolism, 403

53 Temporal Arteritis, 415

54 Intraocular Pressure, 421

55 Asthma, 430

56 Nontraumatic Back Pain, 441

57 Intravascular Volume Status, 450

58 Geriatric Syndromes, 457

Index, 471