In a message dated 08/03/01 10:06:24 GMT, you write:
<< Our speciality is centered around diagnosis. I believe
that we should all understand some of the theory
behind the clinical hx, exam and lots about diagnostic
testing (but there again I am biased). >>
I agree with all the above Simon,
Perhaps the approach to the child in A&E, however deserves a mention
In Paediatric Emergency Medicine a 'definitive' diagnosis is of less
importance than a diagnosis of well vs unwell, and then proceeding to
quantify 'severity' of 'unwell' in A&E. 'Severity of unwell' (stable,
potentially unstable, unstable) then becomes the 'diagnosis'
Clinical risk stratification in terms of diagnosis making, in A&E is well
established using hx, ex + Ix (de dombal, etc) and the basis of many
protocols.
Stratifying 'severity of illness' in children can be done in a moment of time
(APLS) but becomes more difficult when one attempts to describe a trend,
especially in the 'potentially unstable' child without the full resources to
'wait & watch'
It is this trend which I feel is the important 'diagnosis' which 'point'
clinical risk stratification cannot address.
Shafique
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