The rational clinical examination in emergency care.

In the linked study (doi:10.1136/bmj.a2428), Appelboam and colleagues extend this work with the results of the SWEET study—a multicentre prospective diagnostic cohort study that investigates a simple clinical test (extension of the supine elbow) for detecting elbow fracture.10 The authors assessed 1740 adults and children with acute elbow injury and found that inability to extend the elbow fully was highly sensitive for the presence of an elbow fracture. They conclude (with a few caveats about olecranon fractures and uncritical use in children) that the two thirds of patients who cannot fully extend their elbows at presentation should be sent for radiography, but that a fracture can be ruled out in the remainder, who need no further tests.