Published 15 December 2008, doi:10.1136/bmj.a2374
Cite this as: BMJ 2008;337:a2374

Editorials

The rational clinical examination in emergency care

We should tell patients that even highly sensitive tests miss some cases

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

Understanding the patient’s history and interpreting the clinical examination can be challenging in emergencies. Although the immediate presenting problem may be clear—"I’ve hurt my hand" or "I have a cough"—confounding factors such as pain and anxiety may obfuscate the symptoms and mask the signs. In these circumstances a rational approach to clinical assessment is essential.¹

The Ottawa ankle rules are probably the most well known and frequently used clinical decision support rules for use in emergencies.^{2 3} Evidence based approaches have, however, been developed to help in many other emergency situations, including head injury in adults and children,^{4 5} neck injury,⁶ knee injury,⁷ mandibular trauma,⁸ and risk assessment after self harm.⁹

In the linked study (doi:10.1136/bmj.a2428), Appelboam and colleagues extend this work with the results of the SWEET study—a multicentre prospective diagnostic cohort study that investigates a simple clinical test (extension of the supine elbow) for detecting elbow fracture.¹⁰ The . . . [Full text of this article]

¹ Emergency Department, Manchester Royal Infirmary, Manchester M13 9WL

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This article has been cited by other articles:

• (2009). Inability to Extend the Elbow After Acute Injury Predicts Fracture. JWatch Emergency Med. 2009: 2-2 [Full text]  

Rapid Responses:

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How sure can one be?

Sahoo Saddichha
bmj.com, 18 Dec 2008 [Full text]

Patient information is central in his surveillance

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It's all about risk

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