Evidence-Based Emergency Care

Evidence based Emergency Care Diagnostic testing and clinical decision rules (2013) is a paperback handbook providing a concise overview of evidence-based information pertaining to diagnostic tests and decision rules for emergency physicians and emergency medicine trainees. Available in kindle edition and paperback edition.

Firstly for those who forgot their Ritalin this morning or just having a 2 minute LITFL break…the conclusion: This is a good addition to both the Evidence based and Emergency medicine literature. It is recommended for those who would like a short but thorough synopsis of the major areas where diagnostic dilemmas occur and decision rules are most important in our work environment. The book would benefit from an electronic version with links to the online decision rules discussed and recommended.

Authors – Jesse M. Pines, Christopher R. Carpenter, Ali S. Raja, Jeremiah D. Schuur


Upside:

This was an enjoyable, generally well written and paced ride through both the theory and evidence behind many of the more important diagnostic dilemmas in Emergency medicine. It is set out with a thoughtful and approachable theoretical basis and justification for the book. Most of the writing is succinct and accessible.

The book uses the tried and tested format of the EBM question, followed by a summary review of the available literature and then a discussion of what the findings might mean for practitioners.

In important areas such as C-spine rules they also look at important sub-populations e.g. children, elderly etc, which is both thoughtful and useful.

Recommendations and conclusions are suitably guarded at times but provide enough detail for clinicians to formulate rational decisions to use tests and decision rules and more importantly justify those decisions.

The book covers most of the common diagnostic problems seen in the ED and is recommended reading for all levels from junior doctors to departmental directors. Perhaps we could even encourage some of our in-patient colleagues to read it as well!


Downside:

At times there is a bit too much discussion around the evidence, which I suspect ‘non-experts’ would find difficult to follow. Take the chapter on ACS for example. I found the detail presented actually obscured the key findings and the interpretation of those findings. The chapter did not focus on what were acceptable levels of missed cases; what sort of populations should have tests applied; how to select patients for which tests…the sort of information a clinician would need in order to make real life decisions and apply to daily practice.

Some of the introductory comments look somewhat generic and not as well researched as the following reviews. For example in AMI they suggest that “only 50% of patients present with ST elevation on the ECG“. Clearly in current practice that is not the case and probably <20% of AMI presents with ST elevation.

Finally this book would be much better as an electronic version with links to decision rules, statistical calculators and diagnostic aids mentioned throughout the book.

Overall this is a well written, laid out and useful addition to the Emergency literature which would be a much better book if on-line and linked to the many useful diagnostic aids it talks about and recommends.


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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