Article Outline

• Copyright

Simply stated, this is not your average textbook. Dr. Brian Rowe, his co-editors and contributors, have masterfully designed a book to “answer the direct, give-me-the-bottom-line questions emergency physicians ask in the middle of their shifts…” The format is not typical of a textbook, rather it is similar to that of Annals of Emergency Medicine's Evidence-Based Emergency Medicine Series or the Journal of American Medical Association's Rational Clinical Examination Series. The book's 63 chapters are divided into 10 sections including General Issues, Respiratory, Cardiology, General Medical Conditions, Injury, Genitourinary and Abdominal, Neurosciences, ENT, Minor Procedures, and Public Health.

The introduction truly sets the stage for the rest of the book and is a required read. It describes the process of how the clinical questions were developed, how the literature searches were performed, and provides a foundation for some of the basic clinical epidemiology terminology that is used throughout the book. Then, each subsequent chapter begins with a clinical scenario, followed by a few paragraphs describing key background on the topic. Next, several clinical questions are posed. These clinical questions are written in the familiar PICO format (patient, intervention, comparison, outcome). A general search strategy is then described (PubMed versus Cochrane review, versus EmBase, etc) followed by a critical review of the literature for each of the clinical questions. Search strategies for individual questions are also explicitly stated (ie, which keywords and database was used). Each chapter concludes with a summary of the questions reviewed and a wrap-up of the clinical scenario described at the outset. Organizational consistency is maintained throughout the majority of text with the noted exception of the “Conflicts of Interest” section. At the end of many chapters this is included and is a nice touch, especially since many of the authors are experts in the field and some do have ties to industry. In the next edition, I recommend this be included in every chapter.

As would be expected (and a requirement) with this type of text, each chapter is extremely well referenced and the index seems complete and is user friendly. Tables summarizing the multiple studies described and forest plots are abundant. On the other hand, the text is sporadically illustrated; there are a few diagrams, flowcharts, images and occasional radiographs, such as in the shoulder dislocation chapter and the ectopic pregnancy chapter when the use of ultrasound is described. There is a companion Web site at www.blackwellpublishing.com/medicine/bmj/emergencymedicine which simply contains links to other evidence-based medicine Web sites and has a placeholder for updates to be posted (there are no updates as of April 1, 2009). The contents of this text are well suited for a searchable online or mobile version and hopefully the publisher considers this for the future.

This book is dense and definitely does not fall under the category of “light reading.” I found myself having to read only a few chapters at a time. That being said, this will be my new go-to text for evidenced-based answers to specific clinical questions. It belongs in every emergency medicine library, as well as on the shelf of those in charge of journal clubs and evidence-based lecture series.