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Likelihood Ratio (LR) in Emergency Medicine


Sick or not-sick at a glance. Is it reliable?

Clinical scenario

It’s a busy Monday morning in ED, many ambulance are on the go. There’s been a car crash on the high street - says the nurse – we must free the rooms immediately.    There is a full flow now. In a box there is a young man, the doctor observes the patient form the outside, the computer says “dyspepsia and fever”. Blood pressure, temperature, oxygen saturation, heart rate and respiratory rate are normal.
After few seconds of observing, the doctor ask the nurse to invite the patient to leave the room for the arrival of a newer patients. I think he isn’t sick, he can wait - he says.
 In the last room there is an old man just transported from an assisted-living facility because of dyspnoea, fever and cough. Respiratory rates are about 25. A rapid look than the doctor orders for a rapid admission in a non intensive care unit.

How reliable is the first look?