Date: June 6th, 2023

Reference: Pines, Raja, Bellollo and Carpenter. Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules 3rd Edition

Dr. Jesse Pines

Guest Skeptic: Dr. Jesse Pines is the Chief Clinical Innovation at US Acute Care Solutions and a Clinical Professor and George Washington University and Professor of Emergency Medicine at Drexel University. In this role, he focuses on developing and implementing new care models including telemedicine, alternative payment models, and clinical programs involving new technology at USACS. 

Jesse has been on the SGEM before including these two episodes:

  • SGEM#308: Taking Care of Patients Everyday with Physician Assistants and Nurse Practitioners
  • SGEM#316: What A Difference An A.P.P. Makes? Diagnostic Testing Differences Between A.P.P.s and Physicians

Please consider listening to the SGEM Xtra podcast with Jesse discussing the 3rd edition of Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules. I was honoured to be asked to write the foreword to this latest edition.


Emergency physicians are many things but one of the most important things we try to be is great diagnosticians. Every shift we use limited information in a busy, chaotic environment to make decisions. Sometimes those decisions can mean life or death and need to be made quickly. We strive to be the best at exercising this important responsibility. This is the book that can help clinicians achieve that goal.

The first and second edition of Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules is a resource I have used regularly through my career. It has made me a better diagnostician and better physician. Questions come up on every shift as to what evidence supports our actions. This fantastic book provides answers to those questions in a brief and helpful way. I am often accessing it for my own needs and as an educational resource for students.

The third edition contains the foundational elements of providing excellent evidence-based medicine (EBM) care. The authors start by discussing diagnostic testing in the emergency department (ED). They explain the epidemiology and statistics behind diagnostic testing. They appropriately emphasize that clinical decision instruments are tools to guide care, not rules to dictate care. They touch upon the additional responsibility of being good stewards given the realities of limited resources. They also provide a chapter to help clinicians understand the direction of bias in diagnostic research.

The third edition covers dozens of common and deadly conditions clinicians are faced with in the ED. This includes chapters on pediatrics, geriatrics, cardiac, neurological, surgical, trauma, infectious disease, and other conditions.

There are four new chapters in the latest edition of the book: Skin and Soft Tissue Infection, Shared Decision Making, Cognitive Bias and Telemedicine Diagnosis. There are all wonderful additions to the book. My favourite new chapter is the one discussing Shared Decision Making (SDM).

SDM goes beyond informed consent and recognizes the autonomy and agency of patients. We are making important decisions that must consider patients values and preferences. This is one of the three pillars of EBM. While we may be the experts at clinical medicine, patients are experts of their own personal experience. There are many examples of where SDM can be utilized in the ED with my clinical experience to enrich the therapeutic patient-physician alliance.

If you want to provide patients the best care, based on contemporary evidence then this is your book.

Previous Books Highlighted on the SGEM

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So patients get the best care, based on the best evidence.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics Guide to Emergency Medicine.

Further Reading:

  • SGEM#3: To X-ray or not to X-ray (Ottawa Ankle Rule)
  • SGEM#5: Does Johnny “kneed” an X-ray? (Ottawa Knee Rule)
  • SGEM#48: Thunderstruck (Subarachnoid Hemorrhage)
  • SGEM#88: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol)
  • SGEM#106: O Canada- Canadian CT Head Rule for Patients with Minor Head Injury
  • SGEM#170: Don’t Go Breaking My Heart – Ottawa Heart Failure Risk Scale
  • SGEM#201: It’s in the Way That You Use It – Ottawa SAH Tool
  • SGEM#266: Old Man Take a Look at the Canadian CT Head Rule I’m a Lot Like You Were
  • SGEM Xtra: Ian Stiell – Legend of Emergency Medicine
  • Kohn MA, Carpenter CR, Newman TB. Understanding the direction of bias in studies of diagnostic test accuracy. Acad Emerg Med. 2013 Nov
  • First10EM: Clinical Decision Rules are Ruining Medicine