BMJ  2006;333 (26 August), doi:10.1136/bmj.333.7565.0-f

Editor's choice

Diagnosis—the next frontier

The first 150 words of the full text of this article appear below.

This week's bmjupdates+—immediately on the left if you're reading the print journal—looks at the causes of temperatures exceeding 41°C in children presenting to US emergency departments. Fewer than half had any sort of infection; viral infections were as common as bacterial infections; and neither white cell count nor absolute neutrophil count helped to distinguish between viral and bacterial infections.

Once the diagnoses had been made—urinary tract infections caused by Escherichia coli, lobar pneumonias by Streptococcus pneumoniae—the treatment was presumably straightforward. En route to treatment, however, the contribution of the signs (high temperature) and tests (white cell count) to the final diagnosis was anything but straightforward.

The message I take from this is that while evidence based treatment is well on the way to being sorted out, evidence based diagnosis is still in the dark ages. This week's journal suggests that things are beginning to change. In her editorial . . . [Full text of this article]

Tony Delamothe, deputy editor

(tdelamothe@bmj.com)


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