Do textbooks of clinical examination contain information regarding the assessment of critically ill patients?

We postulated that some of the reported deficiencies in trainee doctors' knowledge of acute care might be due to the quantity and quality of available information about the examination and clinical assessment of critically ill patients in commonly used medical textbooks. Using an agreed assessment system, 30 routinely available texts of clinical examination were reviewed. None of these contained a section devoted specifically to "assessing the critically ill patient" and few could be regarded as giving a comprehensive, systematic description of an assessment system suitable for use with the acutely ill. In general, descriptions of how to assess airway patency were rare, with only one describing how to differentiate partial from complete airway obstruction. Only four of the texts mentioned that measuring the respiratory rate would be useful in critically ill patients and the assessment of capillary refill time was poorly covered. Use of the AVPU scale to describe neurological status was found in only 3% of texts, and there was poor description of the clinical significance of hypotension, tachycardia, oliguria, hypothermia and pyrexia. We conclude that the current texts available to medical students and junior doctors do not provide sufficient information regarding the assessment of critically ill patients.