Point-of-Care Guides

These guides offer evidence-based tools to assist family physicians in improving their decision-making at the point of care.

Sep 15, 2016 Issue
Clinical Diagnosis of Gout Without Joint Aspirate
Gout is ideally diagnosed through identification of characteristic negatively birefringent crystals under polarized light microscopy in fluid aspirated from end-organ deposits, typically from a joint. However, fewer than 10% of patients with gout see a rheumatologist, and most cases of gout are diagnosed in the primary care setting based on signs, symptoms, and serum uric acid level. But how accurate is a clinical diagnosis, and can it be done better?

Aug 15, 2016 Issue
Predicting Hospital Readmission
In 2007, the Medicare Payment Advisory Committee reported that 18% of hospital admissions resulted in a readmission, of which 76% were potentially avoidable.1 The development of a clinical decision rule to identify patients at risk of readmission could aid in directing interventions and resources, potentially improving cost-effectiveness of care and reducing postdischarge mortality.

Jun 15, 2016 Issue
Rapid Protocols to Rule out Myocardial Infarction
Cardiac troponin T and I are released into the bloodstream when cardiac muscle is damaged. Cardiac troponin tests have been available for decades and are the preferred biomarkers for the diagnosis of acute myocardial infarction (AMI). However, until recently, they lacked sensitivity in the first few hours following an acute myocardial injury.

Jun 15, 2014 Issue
Diagnosis of Streptococcal Pharyngitis
Sore throat was the chief symptom in 1.3% of all outpatient office visits in 2010, and is even more common in primary care practice. An Australian study found that among families with at least one child three to 12 years of age, the incidence of sore throat was 33 and 14 episodes per 100 person-years in children and their parents, respectively. These episodes were caused by GABHS bacteria in about 40% of children and 25% of adults.

Aug 1, 2012 Issue
Risk Stratification of Children with Bronchiolitis
Bronchiolitis is a common and sometimes serious viral lower respiratory tract infection in young children.

Jun 1, 2012 Issue
Risk Stratification of Patients Presenting with Syncope
A previous Point-of-Care Guide addressed risk stratification in patients with syncope and described two validated clinical decision rules. Shared variables between the two rules included abnormal findings on electrocardiography (ECG) and a history of congestive heart failure; other variables included decreased systolic blood pressure, shortness of breath, anemia, age older than 45 years, and history of arrhythmia.

Mar 1, 2011 Issue
Evaluation of Chest Pain in Primary Care Patients
Chest pain can be caused by conditions that range from benign and self-limited (e.g., chest wall pain) to serious (e.g., anxiety disorder) or life-threatening (e.g., unstable angina, aortic dissection, pulmonary embolism). Accurate identification of life-threatening and serious causes of chest pain must be accomplished without overtesting and overtreating patients with less serious causes.

Jul 15, 2010 Issue
Clinical Diagnosis of Pneumonia in Children
Pneumonia remains a common source of morbidity and mortality in children. A key question in the diagnostic evaluation of children with acute respiratory illness is whether chest radiography should be performed to rule in or rule out the diagnosis of pneumonia. Radiologically, pneumonia is defined as an infiltrate seen on chest radiography in a child with symptoms of an acute respiratory illness.

May 15, 2010 Issue
Diagnosis of Gastroesophageal Reflux Disease
Diagnosis of GERD may be clinical (presentation with typical symptoms, such as heartburn); physiologic (evidence of abnormal pH levels in the distal esophagus); anatomic (evidence of esophagitis on endoscopy); or functional (clinical response to antacid medications). However, the correlation between these diagnostic approaches is relatively poor.

Mar 15, 2010 Issue
Predicting the Risk of Bleeding in Patients Taking Warfarin
When considering anticoagulation therapy in patients with atrial fibrillation or venous thromboembolism (VTE), physicians and patients must balance the benefits of anticoagulation with the risk of bleeding, particularly major bleeding complications. For example, in patients who are at high risk of bleeding, physicians may wish to consider aspirin instead of warfarin, especially if the risk of stroke or recurrent VTE is relatively low.

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