Emergency Medicine

Clinical decision rules for imaging

Clinical decision rules are the backbone of safe, efficient emergency care. The Ottawa Ankle Rules have been validated in over 30 studies to reduce unnecessary radiography by 30-40% while maintaining near 100% sensitivity for clinically significant fractures. Similar Ottawa Rules exist for the knee, cervical spine, and foot.

Chest pain evaluation with the HEART score

Chest pain evaluation in the ED is streamlined by the HEART score, which incorporates History, ECG, Age, Risk factors, and Troponin to stratify major adverse cardiac event (MACE) risk. Patients with HEART scores of 0-3 are low-risk and suitable for early discharge or observation, while scores of 7-10 warrant urgent cardiology consultation and invasive management.

Venous thromboembolism assessment with Wells and PERC

Venous thromboembolism assessment uses the Wells Criteria for both deep vein thrombosis and pulmonary embolism, combined with D-dimer testing in an age-adjusted manner. The PERC rule safely identifies patients with such low pre-test probability that no further testing is required, reducing unnecessary radiation exposure from CT pulmonary angiography.