Improving the dissemination of the rational clinical examination series in emergency medicine☆

Annals of Emergency Medicine initiated the Cochrane systematic review abstracts and commentaries in March 2002, as part of the Evidence-Based Emergency Medicine section of the journal.1 This series presents distillations of systematic reviews performed by the Cochrane Collaboration regarding the effectiveness of therapeutic interventions; emergency physicians select therapy topics applicable to acute care practice and provide a summary of their relevance and position within the field. With this issue, we begin a complementary series of abstracts and commentaries relevant to clinical diagnosis, drawing from the rational clinical examination reviews that have appeared in the Journal of the American Medical Association starting in 1992.2

Emergency physicians make their most important decisions regarding the nature of the illnesses and injuries of their patients on the basis of patients' answers to questions and the results of physicians' assessments made during physical examination. Such questions and assessments constitute diagnostic tests, and their accuracy of performance has now been examined in much the same way as laboratory or imaging tests. The results of clinical assessments, defined as “positives” or “negatives,” are compared with those of a criterion standard for the target condition. The 45 installments of the JAMA rational clinical examination series include systematic reviews that assess and summarize the evidence available from such studies.

The installments of the rational clinical examination series use comprehensive search strategies, use qualitative and quantitative evidence synthesis, and generate summary or pooled sensitivities, specificities, and likelihood ratios for elements of clinical evaluation in relationship to specified clinical conditions and diseases. The installments also identify relevant clinical prediction rules where they exist.

In preparing the rational clinical examination abstracts series for Annals, two of us (DHN and PCW) independently reviewed the JAMA installments published through 2003 and selected those that were both relevant to emergency practice and satisfied minimum quality criteria pertaining to the methodology of systematic reviews. We required that the authors of an installment describe their search strategy and identify the criteria they used to select the studies they included in their review. A list of chosen rational clinical examination installments is available at Annals' Web site.3 This will be updated as new installments continue to appear.

The rational clinical examination abstracts and commentaries follow the same format used for the Cochrane systematic review abstract series.1 They include a structured abstract of the rational clinical examination installment, original author contact information, implications for emergency practice, and a “take home message.” Short, evidence-based teaching points are included for readers interested in learning more about clinically relevant methodology and concepts. We invite emergency physicians and other clinicians to take advantage of this series on the Evidence-Based Emergency Medicine page of Annals' Web site4 when they are in need of distilled information regarding the accuracy of important elements of clinical evaluation. Our goal is to eventually include summaries of all the installments of the parent series of direct interest to emergency practitioners in a fashion aimed at point-of-care access. We encourage reader feedback to assist us in achieving our goal of up-to-date, digestible, and accessible information on history and clinical examination to assist clinicians practicing in the emergency department setting.