EVIDENCE-BASED EMERGENCY CARE
DIAGNOSTIC TESTING AND CLINICAL DECISION RULES
THIRD EDITION

Improve and streamline the diagnostic decision-making process in emergency care

The newly revised third edition of Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules offers an updated review of the evidence and expert discussion of relevant issues in diagnostic testing in the everyday practice of emergency medicine. This book also provides a detailed overview of the science of diagnostic testing and reviews the process behind the development of clinical decision rules. The focus is asking and answering practical questions using original research studies, while commenting on the best available evidence for relevant clinical topics.

Readers will also find:

• Comprehensive explorations of COVID-19, telemedicine, trauma, cardiology, infectious disease, and surgical and abdominal complaints
• Practical discussions of urology, neurology, hematology, ophthalmology, pulmonology, rheumatology, and geriatric medicine
• Exploration of practice and policy considerations of testing in an era of limited resources

The book is perfect for emergency medicine physicians, nurses, and other allied health professionals. Readers of Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules, Third Edition will also earn a place in the libraries of administrators and managers in healthcare settings seeking to optimize the use of scarce resources while maintaining the highest standards of care.

About the Editors x

List of Contributors xiii

Foreword xvi

Acknowledgments xviii

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

1 Diagnostic Testing in Emergency Care 3

2 Evidence- Based Medicine: The Process 14

3 The Epidemiology and Statistics of Diagnostic Testing 23

4 Clinical Decision Rules 43

5 Appropriate Testing in an Era of Limited Resources: Practice and Policy Consideration 53

6 Understanding Bias in Diagnostic Research 73

Section 2: Trauma

7 Cervical Spine Fractures 95

8 Blunt Abdominal Trauma 121

9 Acute Knee Injuries 128

10 Acute Ankle and Foot Injuries 134

11 Blunt Head Injury in Children 141

12 Adult Blunt Head Injury 162

13 Chest Trauma 174

14 Occult Hip Fracture 182

15 Blunt Soft Tissue Neck Trauma 189

16 Occult Scaphoid Fractures 195

17 Penetrating Abdominal Trauma 205

18 Penetrating Trauma to the Extremities and Vascular Injuries 214

Section 3: Cardiology

19 Heart Failure 227

20 Syncope 237

21 Chest Pain 256

22 Palpitations 276

Section 4: Infectious Disease

23 Bacterial Meningitis in Children 291

24 Serious Bacterial Infections in Children Aged 0 to 60/90 Days 299

25 Necrotizing Soft Tissue Infection 309

26 Infective Endocarditis 321

27 Pharyngitis 327

28 Rhinosinusitis 335

29 Pneumonia 340

30 Urinary Tract Infection 353

31 Sepsis 360

32 Adult Septic Arthritis 377

33 Osteomyelitis 388

34 Sexually Transmitted Infections (STIs) 401

35 Influenza 409

36 Fever without a Source 3–36 Months 416

Section 5: Surgical and Abdominal Complaints

37 Acute Nonspecific Nontraumatic Abdominal Pain 425

38 Small Bowel Obstruction 439

39 Acute Pancreatitis 447

40 Acute Appendicitis 457

41 Acute Cholecystitis 472

42 Aortic Emergencies 482

43 Ovarian Torsion 489

Section 6: Urology

44 Nephrolithiasis 499

45 Testicular Torsion 512

Section 7: Neurology

46 Nontraumatic Subarachnoid Hemorrhage 523

47 Acute Stroke 536

48 Transient Ischemic Attack 547

49 First- Episode Seizure 559

Section 8: Miscellaneous: Hematology Ophthalmology Pulmonology Rheumatology and Geriatrics

50 Pulmonary Embolism 571

51 Deep Vein Thrombosis 583

52 Temporal Arteritis 591

53 Intraocular Pressure 598

54 Asthma 608

55 Acute Low Back Pain 621

56 Intravascular Volume Status 631

57 Geriatric Screening 638

58 Skin and Soft Tissue Infections 658

59 Shared Decision- Making in Diagnostic Testing 664

60 Cognitive Biases and Mitigation Strategies in Emergency Diagnosis 678

61 Diagnosis in Telemedicine 699

62 Diagnosing COVID- 19 723

Index 735

Edited by

Jesse M. Pines, MD, MBA, MSCE is the National Director of Clinical Innovation at US Acute Care Solutions and a Professor of Emergency Medicine at Drexel University. He is board-certified in emergency medicine.

Fernanda Bellolio, MD, MSc is the Chair for Research and a Professor of Emergency Medicine in the Department of Emergency Medicine at the Mayo Clinic. She is board-certified in emergency medicine.

Christopher R. Carpenter, MD, MSc is the Director of Evidence Based Medicine and a Professor of Emergency Medicine in the Division of Emergency Medicine at Barnes Jewish Hospital at Washington University. He is board-certified in emergency medicine.

Ali S. Raja, MD, MBA, MPH is Executive Vice Chair of the Department of Emergency Medicine at Massachusetts General Hospital and a Professor of Emergency Medicine at Harvard Medical School. He is board-certified in emergency medicine and clinical informatics.

EVIDENCE-BASED EMERGENCY CARE
DIAGNOSTIC TESTING AND CLINICAL DECISION RULES
THIRD EDITION

Improve and streamline the diagnostic decision-making process in emergency care

The newly revised third edition of Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules offers an updated review of the evidence and expert discussion of relevant issues in diagnostic testing in the everyday practice of emergency medicine. This book also provides a detailed overview of the science of diagnostic testing and reviews the process behind the development of clinical decision rules. The focus is asking and answering practical questions using original research studies, while commenting on the best available evidence for relevant clinical topics.

Readers will also find:

• Comprehensive explorations of COVID-19, telemedicine, trauma, cardiology, infectious disease, and surgical and abdominal complaints
• Practical discussions of urology, neurology, hematology, ophthalmology, pulmonology, rheumatology, and geriatric medicine
• Exploration of practice and policy considerations of testing in an era of limited resources

The book is perfect for emergency medicine physicians, nurses, and other allied health professionals. Readers of Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules, Third Edition will also earn a place in the libraries of administrators and managers in healthcare settings seeking to optimize the use of scarce resources while maintaining the highest standards of care.