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As the arsenal of clinical investigations is continuously changing, it can be challenging to choose the right test for your patient. Novel tests arrive and supersede old ones; indications for established tests change; test results have to be reinterpreted in the light of new evidence. Inappropriate testing can have a range of negative consequences, from adding nothing to the patient's management, generating confusion and at worst providing false reassurance. To help paediatricians make best use of the plethora of tests at their disposal, we at E&P have devised Interpretations. Here, I present the format with the aim to encourage you, our reader, to pick up a pen and to start writing.
Aim
The aim of Interpretations is to educate paediatricians about the utility of tests. Interpretations should highlight when not to use a test and the limits of the interpretation of test results.
Topics and authors
Any test used in paediatric practice lends itself to an Interpretation including everyday tests, specialist tests, whether performed in a laboratory, at the bedside or in the radiology department. Another category of tests that may be discussed are clinical examination techniques, which we are particularly keen to publish on (but are still awaiting a first submission of). Although a senior author with specialist knowledge on the test is required, Interpretations can be written by paediatricians of any grade. The registrar on the shop floor is arguably in the best position to ask relevant questions.
Format
Format and formalities are outlined in boxes 1 and 2, respectively. Common pitfalls are summarised in box 3 and a submission checklist provided in box 4. The single most important point to make about the format is that an Interpretation is not a standard review in disguise. We have developed, and are prescribing, a very specific format for Interpretations which may appear rigid and awkward to write at first. However, it does seem to work for our readers who know what information they can expect to find in an Interpretation.
Format
Title: “How to use … TEST X”
Introduction: To place the test and its current use in context.
Physiological background: A brief discussion of relevant physiological concepts. Use diagrams.
Technological background: This should be a brief, not too technical description of the test. Only include essential information that is required to be able to understand the test and its limitations. Include details about requirements for specimens, collection and handling. Include common mistakes that occur during sample collection which may invalidate the test result. Use diagrams.
Indications and limitations: Refer to main text.
Topics for further research: A brief section that highlights pertinent questions that need to be addressed.
Clinical bottom line: A series of bullet points (no more than five) for a reader to assess and assimilate.
Multiple choice questions (MCQs): Please submit at least five MCQs (with answers) covering the topic of your paper.
Text boxes: These should be used to summarise salient points or move content out of the main text.
Formalities
Presubmission: In the first instance, please contact me with a short proposal (half a side of A4) outlining what the paper is about and which clinical questions you want to ask.
Submission: Through the journal's online submission system upon invitation, as this is a commissioned series.
Diagrams: We will include colour diagrams in the print version of the journal (free of charge). Please make use of this offer.
Length: 2000 to 3000 words (excluding references).
References: No more than 20 references can be accommodated in the print version of the paper. Unfortunately, this limit is non-negotiable.
Search strategy: please include a brief description of your search strategy in an appendix.
Peer review: All articles will be peer-reviewed.
Common pitfalls
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Author wants to write a disease management review (eg, Best practice) instead of an Interpretation.
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Questions of clinical scenarios are too vague and non-specific.
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In the discussion of questions, personal experience rather than research evidence is referred to.
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Use of the test in newborns is not considered.
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No figures, summary boxes, tables are included.
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Excessive detail in technological background.
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Checklist not checked (box 4).
Submission checklist
To be used in conjunction with general submission guidelines
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[ ] Article discussed with editor in advance
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[ ] All formalities of box 2 adhered to
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[ ] Length of article is not more than 3000 words
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[ ] A maximum of 20 references is cited
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[ ] Search strategy appended
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[ ] At least five MCQs with answers have been appended
The clinical scenarios are the backbone of Interpretations through which authors discuss the use of tests performed within a specific context in a specific patient group. In other words—this is another ‘single most important point’—these clinical scenarios use the PICO (patient, intervention, comparison, outcome) format of evidence-based medicine.1 What we are not looking for are non-specific questions such as: What does the test result mean? Such questions tend to produce answers of little practical value. Instead, specific questions are required which generate practically useful answers. The above question, therefore, might be better posed as: ‘In newborns presenting with X, do positive test results (intervention) rule in (outcome) a diagnosis of Y?’ The implicit comparison in this question is to the pretest probability of diagnosis Y.
The answers to these questions should be argued with reference to research evidence. In the absence of research evidence, expert opinion for example, consensus guidelines, can be cited. If neither exists, personal practice (ie, anecdotal evidence) may be referred to while clearly marked as such. We encourage the use of numbers, such as pretest and post-test probabilities, predictive values, sensitivities, specificities, normal values, where appropriate. An impressive example of how to use numbers is the Interpretation on urinary catecholamines.2 We have reproduced here one of the key tables from that paper (table 1). At a glance it provides an overview of how to interpret urinary catecholamines in different population groups, stratified by pretest probabilities.
An example of how to use numbers in an Interpretation
Concluding remarks
We aim to build up a repertoire of Interpretations over the coming years which will serve as a reference source for the practicing paediatrician. We would like to encourage our readers to contribute to this endeavour. If you want to suggest a topic, to write one yourself, or to make any other comments, drop me a line at archdischild@bmjgroup.com.
Footnotes
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.