Users' guide to the surgical literature: how to use a decision analysis.

After a long night on call, a general surgery resident on a vascular surgery rotation meets a radiology resident at the hospital coffee shop, and they begin to discuss interesting consults from the previous night. She mentions to her radiology colleague that she had been called to the emergency department to see an elderly gentleman with peripheral vascular disease, and she had found an asymptomatic carotid bruit during her clinical examination. After hearing the case, the keen radiology resident suggests ordering an angiogram of the carotid and vertebral arteries, stating that the clinical exam likely indicates the presence of carotid stenosis, heralding the need for surgical intervention. The surgical resident feels that the presence of a carotid bruit is a poor predictor of a surgically important carotid lesion and is unsure whether any investigation or surgical intervention would provide clinical benefit in an asymptomatic patient. Both residents admit that they needed more information, so they set out to find the nearest computer to do a literature search.