The main goal of emergency medicine is to recognize and treat acute medical conditions and then to make an appropriate disposition (admit to a specific hospital unit or discharge home). The process for making a diagnosis and selecting a therapeutic option is well known by emergency physicians. However, the etiology of a given disorder is usually considered less important by emergency physicians, who believe that such considerations can wait and be performed in the appropriate unit (if the patient is hospitalized) or in a primary care setting. A good illustration of this is the significantly lower proportion of literature citations in PubMed of the term “causality” in the emergency medicine literature compared to some other medical specialties (Table 1). However, considering causality in the diagnostic process, as well as severity of distress, may improve the accuracy of the diagnosis (by significantly changing the post-test probability) or the choice of therapy. For instance, in the case of a patient complaining of acute chest pain, the evaluation of a possible acute coronary syndrome should include an assessment for evidence of atherosclerosis and its risk factors. The presence (or absence) of certain risk factors significantly modifies the probability of acute coronary syndrome (
1). Early treatment for acute coronary syndrome includes atherosclerosis management as well. There are other examples for which risk factors are clearly identified and the diagnosis is not simple (e.g., deep venous thrombosis risk factors in the diagnosis of pulmonary embolism, or specific allergen exposure and asthma) (
- Swap C.J.
- Nagurney J.T.
Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes.
JAMA. 2005; 294: 2623-2629
- Chagnon I.
- Bounameaux H.
- Aujesky D.
- et al.
Comparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism.
Am J Med. 2002; 113: 269-275
3). The search for risk factors in the early phase of care can improve the diagnosis and assist in selecting appropriate treatments. Further studies are needed to assess how causality can improve diagnostic accuracy in emergency care.
- Sykes A.
- Johnston S.L.
Etiology of asthma exacerbations.
J Allergy Clin Immunol. 2008; 122: 685-688
Table 1Proportion of Citations in PubMed that Include “Causality,” by Medical Specialty, in the Last 10 Years (Using Medical Subject Heading Terms)
|Number of Citations in the Last 10 Years, for the Specialty||Number of Citations in the Last 10 Years, for the Specialty AND Causality||Proportion|
|TOTAL (emergency medicine excluded)||493,638||244,456||49.5%|
(Performed April 11, 2009).
p < 0.0001, χ2 test between Emergency Medicine and other specialties searched.
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- Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes.JAMA. 2005; 294: 2623-2629
- Comparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism.Am J Med. 2002; 113: 269-275
- Etiology of asthma exacerbations.J Allergy Clin Immunol. 2008; 122: 685-688
Published online: February 01, 2010
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.