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Doody's Review ServiceReviewer: Peder Todd Lindberg, MD, PhD (University of Chicago Pritzker School of Medicine)
Description: A systems-based collection of randomized trials, meta-analyses, and brief discussions of practical questions of best practice in the emergency department, this book is a concise presentation of the conclusions of landmark studies, and the analysis involved in their production.
Purpose: No doubt inspired by the groundbreaking research in the field, this book is an attempt to collect and emphasize the tested hypotheses for the emergency department to guide practitioners. The book attempts not only to answer particular questions in an accessible manner, but also to familiarize clinicians with the tools of critical testing.
Audience: The audience is emergency medicine practitioners, physicians intent on making real-life decisions based on well-performed studies. The authors demonstrate the scope of their knowledge in each chapter.
Features: Each chapter addresses around a dozen concrete questions on treatment and presents the evidence in support of each conclusion. Frequently, there are meta-analyses in the style of the Cochrane Review, as the authors are associated with the Cochrane Group. Each chapter starts with a case, highly relevant to any practitioner's last shift. Then a series of questions are addressed, constantly related back to patient care. Data from the relevant studies are reported and summarized, and a brief conclusion is stated. While this is a convenient collection of studies, it probably attempts to do what is impossible for a book. It doesn't lend itself to an easy flow because each question is a study in its own right. At the same time, there are better resources already available (for example, the online Cochrane Database itself) for the reader who has one particular question. Although the book is a good collection of the extensive body of work that exists to guide practice, it suffers from the inevitable handicaps of a book compared to the Internet, or to the original papers on which it is based. Space is much more valuable in a book, it is harder to revise in the face of constantly progressing research, and it is impossible to really present the controversy embodied in each of the details of a study. Inevitably with questions that are addressed by data, there will be questions of the adequacy of the studies. Certainly, the authors might refer to the references for the curious, but anyone who is curious enough to pick up the book will be referred to the original papers often enough to counteract any convenience derived from the book. In the end, this book is not better at answering particular questions than is the Cochrane Database or other online resources. It is not as detailed as original articles. It is neither as comprehensive nor as engaging as the landmark textbooks in the field. It is not as complete on each topic as are published discussions of current controversies and it is, by its very nature, behind the cutting-edge and doomed to be more so as research continues. Nevertheless, the book is very carefully researched and well organized. It would be an excellent tool for students who have not yet grasped evidence-based medicine or practitioners who have, until now, only dealt with the same old way of doing medicine. Unfortunately, neophytes certainly have more pressing resources available, and the as-yet evidence-resistant physician is likely to remain so.
Assessment: This book is certainly original. I know of no other work that attempts the challenge of collecting the great research that has been done in emergency medicine. The landmark texts in the field (Rosen's Emergency Medicine: Concepts and Clinical Practice, 6th edition, Marx et al. (Elsevier, 2006), Emergency Medicine: A Comprehensive Study Guide, 6th Edition, Tintinalli et al. (McGraw-Hill, 2004), and now Emergency Medicine, Adams et al. (Elsevier, 2008)) would be most similar, but are not really good comparisons. This book alone takes on the difficult challenge of reviewing the evidence-based decisions that are still not ubiquitous in the emergency departments of America.