BET 1: Does a normal D-dimer rule out cerebral venous sinus thrombosis (CVST)?

Jean-Francois Hibbert recommends Clinical scenario

A 32-year-old woman presented to the emergency department (ED) with a history of occipital headache and intermittent blurred vision for the past 3 weeks. D-dimer performed on admission is within normal range. Can you safely rule out cerebral venous sinus thrombosis (CVST)?

Three-part question

In (patients presenting to and ED with suspected CVST) does a (normal D-dimer) rule out this condition?

Search strategy

NICE Healthcare interface Medline 1966–November 2016

[ddimer.ti,ab] AND [exp INTRACRANIAL EMBOLISM/OR exp INTRACRANIAL THROMBOSIS/OR exp SINUS THROMBOSIS, INTRACRANIAL/OR exp CAVERNOUS SINUS THROMBOSIS/OR exp INTRACRANIAL EMBOLISM AND THROMBOSIS/OR exp LATERAL SINUS THROMBOSIS/OR exp SAGITTAL SINUS THROMBOSIS/OR (cerebral AND venous AND sinus AND thrombosis).ti,ab/OR (sinus AND thrombosis).ti,ab] AND [exp DIAGNOSIS/OR (rule AND out).ti,ab/OR exclu*.ti,ab/OR normal.ti,ab/OR negative.ti,ab/OR sensitivity.ti,ab/OR diagnosis.ti,ab]

Search outcome

Seventy-one papers were identified, of which 52 were irrelevant and 7 were of insufficient quality for inclusion.

Twelve papers were included for use in final review. This included two systematic reviews that…

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2LjFEyE

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Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary

Jean-Francois Hibbert recommends

Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line that indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again.

The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here together with those published previously and those currently…

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2ICvRSH

BET 2: Utility of the speed bump sign in diagnosis of acute appendicitis

Jean-Francois Hibbert recommends Clinical scenario

You are working in A&E and have just reviewed a patient with symptoms and clinical signs consistent with suspected acute appendicitis; you wonder whether there are any further clinical signs that may help your diagnosis and a referral to general surgery.

You recall hearing of the speed bump sign from a colleague and wonder how useful this sign is in the diagnosis of acute appendicitis.

Three-part question

(In adult patients) is (reported pain whilst travelling over speed bumps) indicative of (acute appendicitis?)

Search strategy

Medline 1946–February 2017 using the Ovid interface

Search terms: (appendicitis and (speed bump* OR bump*)).mp

Search outcome

Three search results.

One of which was a news article referring to one of the other two results, so it was excluded.

Of the remaining two, one paper directly referred to speed bumps; the other referred to bumps in the…

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2LfuHhw

BET 1: Can Salter-Harris type I fractures be diagnosed by ultrasound?

Jean-Francois Hibbert recommends

A short-cut review was carried out to establish the diagnostic accuracy of ultrasound for Salter-Harris type 1 fractures. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that ultrasound may allow visualisation of Salter-Harris type 1 fractures. However, little is known as to its sensitivity and specificity, and therefore it cannot be used to eliminate the diagnosis.

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2qKXstb

Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary

Jean-Francois Hibbert recommends

Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again.

The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here, together with those published previously and those currently…

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2HcmvjM

Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary

Jean-Francois Hibbert recommends

Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again.

The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary1 or placed on the BestBETs website. Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here, together with those published previously and those currently…

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2HcmvjM

BET 2: Blood biomarkers as an alternative to imaging in diagnosing acute ischaemic stroke

Jean-Francois Hibbert recommends

A short-cut review was carried out to establish the diagnostic accuracy of blood biomarkers as an alternative to imaging for the diagnosis of ischaemic stroke. Nine studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that that blood biomarkers are currently not suitable for the diagnosis of acute ischaemic stroke.

from Emergency Medicine Journal Best evidence topic reports https://ift.tt/2qL7REV