Author: Susie Roy / Codes:  MaP1, SLO1, SLO10 / Published: 15/07/2019


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  • Hans Antov
  • Mohammed Suida

What this paper adds

This letter provides a comprehensive and succinct approach to a simple dental anaesthesia which can be used to manage dental pain in the ED

The Paper

Dental Anaesthesia in the Emergency Department

Our take home

Think differential for dental pain especially in the unwell looking patient. Optimise analgesia using conventional methods and local anaesthetic. Engage colleagues early if concerned about the progression of dental pain and symptoms. Consider wider global context and dental pathologies.

RCEM curriculum coverage

CAP 21: Neck Pain (Ludwicks Angina)

CMP4: Septic Patient

HAP9: Dental emergencies

RCEM Learning

EM Cases (Ludwigs and Dental infection)


  • Andrew Tabner
  • Graham Johnson
  • (Harry and Eddie Johnson)


In this two-part series on sources of bias in studies of diagnostic test performance, we outline common errors and optimal conditions during three study phases: patient selection, interpretation of the index test and disease verification by a gold standard. Here in part 1, biases associated with suboptimal participant selection are discussed through the lens of partial verification bias and spectrum bias, both of which increase the proportion of participants who are the ’sickest of the sick’ or the ’wellest of the well.’ Especially through retrospective methodology, partial verification introduces bias by including patients who are test positive by a gold standard, since patients with a positive index test are more likely to go on to further gold standard testing. Spectrum bias is frequently introduced through case–control design, dropping of indeterminate results or convenience sampling. After reading part 1, the informed clinician should be better able to judge the quality of a diagnostic test study, its inherent limitations and whether its results could be generalisable to their practice. Part 2 will describe how interpretation of the index test and disease verification by a gold standard can contribute to diagnostic test bias.

The Paper

Kennedy Hall, Bory Kea, Ralph Wang

Recognising Bias in Studies of Diagnostic Tests Part 1: Suboptimal Patient Selection

Emerg Med J Epub ahead of print doi:10.1136/ emermed-2019-208446

What was discussed in the podcast?

Sensitivity, specificity, likelihood ratios, positive and negative predictive value

Bias in patient selection, including partial verification bias and spectrum bias

Metal detectors, pirate treasure and bad behaviour

RCEM curriculum coverage

CC 20: Ethical Research

RCEM Learning

A variety of articles relevant to the podcast can be found in the Critical Appraisal section of RCEM Learning

Other Resources

There are also a variety of helpful resources on the BestBets website, under the “Resources” tab