Rational Clinical Examination Series

 But first!!!

Email from the CMO of UUH: Procalcitonin now available for ED testing to evaluate for Sepsis/SIRS.

Essential Evidence Plus



What sort of article are we reading – how should we prepare?


  • JAMA Site – Rational Clinical Examination Series



  • Systematic Review Validity


  • Diagnostic Test Validity


  • What can this study tell us? (what are the questions?)
    • prevalence of bacteremia
    • usefulness of blood cultures in detecting bacteremia



Levels of Evidence?

What evidence do we look for to answer the question?


Level 1 evidence

greater than 100 subjects, consecutive enrollment 

level 2 evidence

Prospective, fewer than 100 subjects, consecutive enrollment

level 3 evidence


level 4 evidence

any study of patients looking at possible bacteremia





Likelihood Ratio Ranges/Interpretation

Derivation and Validation Sets