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Stroobant and Field, perhaps the longest standing editorial partnership in UK paediatrics, have done it again. This time they shrewdly spied a gap in the market for a home grown concise book for everyday use aimed specifically at answering the question: “what tests?”
How best to review it? Why not try “road testing” it on a few problems this general paediatrician happens to have seen on the wards recently.
Firstly, a 12 year old with painless microscopic haematuria. We find the expected exhortation to take a full history and do a thorough examination, followed by a friendly table listing the more straightforward tests, and a discussion of the more fancy ones to be considered. The point about this sort of book, of course, is to supply reminders and hints about what to consider, rather than lists to follow slavishly.
Secondly, a pair of brothers whose bones keep breaking. Are there any tests worth doing to look for osteogenesis imperfecta? Nothing at all on this, but maybe that’s a bit too specialised for this small book.
Next patient, one of those worrying “funny bruising” problems: is it NAI, or is there a rare clotting/platelet disorder? There’s no schema for investigating easy bruising as such, but platelet function and coagulation disorders are discussed. There are useful tables of all the tests haematologists can do, and looking at these enables the paediatrican to sound less clueless when discussing them. There are also tips on how to take the specimens properly.
What about a child who has suddenly put on weight? What tests will rule out an organic cause? A brief paragraph helpfully distinguishes between tests to find the cause and tests to look for complications, and a table lists what investigations might be worth doing, including the rarities.
A 10 year old comes in with weak, painful limbs and unable to stand. Is it a viral myositis or something more sinister? Difficult to find all the answers in one place, but the tables on “acute generalised weakness” list some of the causes, including some one might not think of, and what tests might exclude them.
My conclusion? This handbook doesn’t pretend to be a mini textbook, and within its limits achieves what it sets out to do very well. It’s written in an accessible style with lots of quick reference boxes, and a few flow charts and illustrations. The index is somewhat limited and it may take a while to find what one is looking for. Some sort of index allowing cross reference by clinical presentation rather than by system would be a nice addition—for example, “gone off feet”: what lists to look at? There are, inevitably, gaps, and bigger texts will be needed at times. That said, it is well suited for constant use by all in wards and clinics, is reasonably priced, and is already very popular.
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