Main description:

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

Back cover:

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

Contents:

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