Aine Kelly (editor) - Evidence-Based Emergency Imaging: Optimizing Diagnostic Imaging of Patients in the Emergency Care Setting (Evidence-Based Imaging)

Nicklaus Childrens Hospital, Miami Childrens Health Systems, Miami, FL, USA

Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA

Department of Radiology, Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, WA, USA

Department of Radiology, University of Kentucky Childrens Hospital, Lexington, KY, USA

Department of Diagnostic Radiology, Puerto Rico Childrens Hospital, Bayamn, Puerto Rico

L. Santiago Medina (Corresponding author)

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C. Craig Blackmore

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Kimberly E. Applegate

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Enrique Alvarado

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The first step in the EBI process is formulation of the clinical question . The entire process of EBI arises from a question that is asked in the context of clinical practice. However, often formulating a question for the EBI approach can be more challenging than one would believe intuitively. To be approachable by the EBI format, a question must be specific to a clinical situation, a patient group, and an outcome or action. For example, it would not be appropriate to simply ask which imaging technique is better computed tomography (CT) or radiography. The question must be refined to include the particular patient population and the action that the imaging will be used to direct. One can refine the question to include a particular population (which imaging technique is better in pediatric victims of high-energy blunt trauma) and to guide a particular action or decision (to exclude the presence of unstable cervical spine fracture). The full EBI question then becomes, in pediatric victims of high-energy blunt trauma, which imaging modality is preferred, CT or radiography, to exclude the presence of unstable cervical spine fracture? This book addresses questions that commonly arise when employing an EBI approach for conditions encountered by the emergency care provider and radiologist. These questions and issues are detailed at the start of each chapter. One popular method used to teach how to develop a good clinical question is called the PICO ( P atient, I ntervention, C omparison, O utcome) format. This method provides structure to formulate the necessary elements for a good clinical question that includes information about the patient, the problem to be solved, the intervention (such as a diagnostic test) and its comparison intervention (perhaps a newer diagnostic test), and the outcome of interest (e.g., what the patient wants or is concerned about).

The process of EBI requires timely access to the relevant medical literature to answer the question. Fortunately, massive online bibliographical references such as PubMed, Embase, Cochrane, and the Web of Science databases are available. In general, titles, indexing terms, abstracts, and often the complete text of much of the worlds medical literature are available through these online sources. Also, medical librarians are a potential resource to aid identification of the relevant imaging literature. A limitation of todays literature data sources is that often too much information is available and too many potential resources are identified in a literature search. There are currently over 50 radiology journals, and imaging research is also frequently published in journals from other medical subspecialties. We are often confronted with more literature and information than we can process. The greater challenge is to sift through the literature that is identified to select that which is appropriate.