Evidence-Based Emergency Care Diagnostic Testing and Clinical Decision Rules

Jesse M. Pines, MD, MBA; Director, Center for Health Care Quality, Associate Professor Emergency Medicine and Health Policy, George Washington University, Washington, D.C., USA

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

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