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Clinical Decision Rule

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1. Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department (PubMed)

Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head (...) injury.This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Phys icians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test

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2018 EvidenceUpdates

2. "HERDOO2" clinical decision rule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer?

"HERDOO2" clinical decision rule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer? The "HERDOO2 rule" is a prospectively validated clinical decision rule used to identify low-risk women who can safely discontinue anticoagulants after completing 5-12 months of anticoagulant treatment for unprovoked venous thromboembolism. The VIDAS®d-Dimer (DD) assay, a component of the rule, was used in the derivation and validation of the rule at half (...) , -0.004-0.07)).The "HERDOO2 rule" is the only prospectively validated clinical decision rule that can be used to identify low-risk women with unprovoked venous thrombosis who can safely discontinue anticoagulants. An important implementation issue is whether any commercial DD assay can be used in the HERDOO2 rule, and at what cut-point. Our analysis shows that the HemosIL®, Innovance®, Liatest® and Tina-quant® DD assays should not be used in the "HERDOO2" rule due to poor concordance with the VIDAS®

2018 EvidenceUpdates

3. The Ottawa subarachnoid hemorrhage clinical decision rule for classifying emergency department headache patients. (PubMed)

The Ottawa subarachnoid hemorrhage clinical decision rule for classifying emergency department headache patients. Subarachnoid hemorrhage (SAH) is a serious cause of headaches. The Ottawa subarachnoid hemorrhage (OSAH) rule helps identify SAH in patients with acute nontraumatic headache with high sensitivity, but provides limited information for identifying other intracranial pathology (ICP).To assess the performance of the OSAH rule in emergency department (ED) headache patients and evaluate (...) its impact on the diagnosis of intracranial hemorrhage (ICH) and other ICP.We conducted a retrospective cohort study from January 2016 to March 2017. Patients with acute headache with onset within 14 days of the ED visit, were included. We excluded patients with head trauma that occurred in the previous 7 days, new onset of abnormal neurologic findings, or consciousness disturbance. According to the OSAH rule, patients with any included predictors required further investigation.Of 913 patients

2019 American Journal of Emergency Medicine

4. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring (PubMed)

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency (...) department.We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months. We collected standardized baseline characteristics, findings from clinical evaluations and predictors for the Ottawa Chest Pain Cardiac Monitoring Rule: whether the patient is currently free of chest pain, and whether the electrocardiogram is normal or shows only nonspecific changes. The outcome was an arrhythmia requiring

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2017 EvidenceUpdates

5. Clinical decision rule for non-traumatic computed tomography of the brain. (PubMed)

Clinical decision rule for non-traumatic computed tomography of the brain. The aims of the present study were to derive and validate a clinical decision rule (CDR) to rule out the need for computed tomography of the brain (CTB) in non-traumatic patients who present to the ED.This is a retrospective review of non-traumatic patients who presented to the EDs in two urban hospitals and received CTB from January 2014 to December 2016. Data from one hospital were used to develop a CDR for clinically (...) significant CTB findings. Clinically significant CTB findings were defined as acute infarction, intracranial neoplasm, intracranial haemorrhage, acute hydrocephalus, cerebral oedema and intracranial infection. Patients from another hospital were used as a validation cohort to evaluate the CDR and compare it to four previously derived CDRs.There were 5296 cases in the derivation cohort, with 345 (6.5%) clinically significant CTB findings. Identified risk factors were: focal neurological deficit (adjusted

2019 Emergency medicine Australasia

6. External validation of a clinical decision rule: we need events in a population in order to rule them out! (PubMed)

External validation of a clinical decision rule: we need events in a population in order to rule them out! We respond to the Lorton et al. article on external validation of the PECARN study. With an event rate of only 0.6%, we believe that their study failed to confirm the safety of this rule. Such a low number of events should call for caution when interpreting the results of diagnostic tests.

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2017 Scandinavian journal of trauma, resuscitation and emergency medicine

7. AHRQ White Paper: Use of Clinical Decision Rules for Point-of-Care Decision Support. (PubMed)

AHRQ White Paper: Use of Clinical Decision Rules for Point-of-Care Decision Support. Translation of research into clinical practice remains a barrier, with inconsistent adoption of effective treatments and useful tests. Clinical decision rules (CDRs) integrate information from several clinical or laboratory findings to provide quantitative estimates of risk for a diagnosis or clinical outcome. They are increasingly reported in the literature and have the potential to provide a bridge that helps (...) translate findings from original research studies into clinical practice. Unlike formal aids for shared decision making, they are pragmatic solutions that provide discrete quantitative data to aid clinicians and patients in decision making. These quantitative data can help inform the informal episodes of shared decision making that frequently take place at the point of care. Methods used to develop CDRs include expert opinion, multivariate models, point scores, and classification and regression trees

2017 Medical Decision Making

8. Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention (PubMed)

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care.The objective (...) of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care.This study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived

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2016 JMIR medical informatics

9. Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial. (PubMed)

Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial. The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether (...) the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems.Multi

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2018 Medical Informatics and Decision Making

10. Derivation of a Clinical Decision Rule for Emergency Department Head CT Scanning in Seniors Who Have Fallen

Derivation of a Clinical Decision Rule for Emergency Department Head CT Scanning in Seniors Who Have Fallen Derivation of a Clinical Decision Rule for Emergency Department Head CT Scanning in Seniors Who Have Fallen - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (...) (100). Please remove one or more studies before adding more. Derivation of a Clinical Decision Rule for Emergency Department Head CT Scanning in Seniors Who Have Fallen The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier

2018 Clinical Trials

11. The DIPEP (Diagnosis of Pulmonary Embolism in Pregnancy) Study and the limited accuracy of Clinical Decision Rules and D-dimer: what next? (PubMed)

The DIPEP (Diagnosis of Pulmonary Embolism in Pregnancy) Study and the limited accuracy of Clinical Decision Rules and D-dimer: what next? 29873174 2019 03 13 2019 03 13 1471-0528 126 3 2019 02 BJOG : an international journal of obstetrics and gynaecology BJOG The DiPEP (diagnosis of pulmonary embolism in pregnancy) study and the limited accuracy of clinical decision rules and D-dimer: what next? 393 10.1111/1471-0528.15309 Okonofua F F Obstetrics and Gynaecology, College of Medical Sciences

2018 BJOG

12. How to use the Kaiser score as a clinical decision rule for diagnosis in multiparametric breast MRI: a pictorial essay (PubMed)

How to use the Kaiser score as a clinical decision rule for diagnosis in multiparametric breast MRI: a pictorial essay Due to its superior sensitivity, breast MRI (bMRI) has been established as an important additional diagnostic tool in the breast clinic and is used for screening in patients with an elevated risk for breast cancer. Breast MRI, however, is a complex tool, providing multiple images containing several contrasts. Thus, reading bMRI requires a structured approach. A lack (...) of structure will increase the rate of false-positive findings and sacrifice most of the advantages of bMRI as additional work-up will be required. While the BI-RADS (Breast Imaging Reporting And Data System) lexicon is a major step toward standardised and structured reporting, it does not provide a clinical decision rule with which to guide diagnostic decisions. Such a clinical decision rule, however, is provided by the Kaiser score, which combines five independent diagnostic BI-RADS lexicon criteria

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2018 Insights into imaging

13. Clinical decision rules in emergency care (PubMed)

Clinical decision rules in emergency care 29749424 2018 10 24 2018 11 14 0037-5675 59 4 2018 04 Singapore medical journal Singapore Med J Clinical decision rules in emergency care. 169 10.11622/smedj.2018042 Lim Swee Han SH eng Editorial Singapore Singapore Med J 0404516 0037-5675 IM Adult Aged Canada Child Decision Making Decision Support Systems, Clinical Emergency Medical Services methods Emergency Service, Hospital Emergency Treatment methods Female Humans Pneumonia diagnosis Retrospective

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2018 Singapore medical journal

14. Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil? (PubMed)

Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil? This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability to the Singapore adult population with minor head injury.We conducted a retrospective study over six months of consecutive patients who presented to the adult emergency department (ED) with minor head injury. Data on predictor variables (...) indicated in the CCHR was collected and compliance with the CCHR was assessed by comparing the recommendations for head computed tomography (CT) to its actual usage.In total, 349 patients satisfied the inclusion criteria. Common mechanisms of injury were falls (59.3%), motor vehicle crashes (16.9%) and assault (12.0%). 249 (71.3%) patients underwent head CT, yielding 42 (12.0%) clinically significant findings. 1 (0.3%) patient required neurosurgical intervention. According to the CCHR, head CT

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2018 Singapore medical journal

15. Acceptability of a Mobile Clinical Decision Tool Among Emergency Department Clinicians: Development and Evaluation of The Ottawa Rules App (PubMed)

Acceptability of a Mobile Clinical Decision Tool Among Emergency Department Clinicians: Development and Evaluation of The Ottawa Rules App The Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule-together known as The Ottawa Rules-are a set of internationally validated clinical decision rules developed to decrease unnecessary diagnostic imaging in the emergency department. In this study, we sought to develop and evaluate the use of a mobile app version of The Ottawa Rules.The primary (...) to colleagues (81/108, 75.0%), and that they would continue using the app (73/108, 67.6%). Feedback from study participants highlighted a desire for access to more clinical decision rules and a higher degree of interactivity of the app. Between April 21, 2016, and June 1, 2017, The Ottawa Rules app was downloaded approximately 4000 times across 89 countries.We have found The Ottawa Rules app to be an effective means to disseminate the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule among all

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2018 JMIR mHealth and uHealth

16. Best practices for preventing malfunctions in rule-based clinical decision support alerts and reminders: Results of a Delphi study. (PubMed)

Best practices for preventing malfunctions in rule-based clinical decision support alerts and reminders: Results of a Delphi study. Developing effective and reliable rule-based clinical decision support (CDS) alerts and reminders is challenging. Using a previously developed taxonomy for alert malfunctions, we identified best practices for developing, testing, implementing, and maintaining alerts and avoiding malfunctions.We identified 72 initial practices from the literature, interviews (...) , deployment, monitoring and feedback, and people and governance. Round 2 developed consensus on the importance and feasibility of each best practice.The Delphi panel identified a range of best practices that may help to improve implementation of rule-based CDS and avert malfunctions. Due to limitations on resources and personnel, not everyone can implement all best practices. The most robust processes require investing in a data warehouse. Experts also pointed to the issue of shared responsibility between

2018 International journal of medical informatics

17. The "Petechiae in children" (PiC) study: evaluating potential clinical decision rules for the management of feverish children with non-blanching rashes, including the role of point of care testing for Procalcitonin & Neisseria meningitidis DNA - a stu (PubMed)

The "Petechiae in children" (PiC) study: evaluating potential clinical decision rules for the management of feverish children with non-blanching rashes, including the role of point of care testing for Procalcitonin & Neisseria meningitidis DNA - a stu Children commonly present to Emergency Departments (ED) with a non-blanching rash in the context of a feverish illness. While most have a self-limiting viral illness, this combination of features potentially represents invasive serious bacterial (...) ) clinicians on research without prior consent using qualitative methodology Report on the aetiology of NBRs in children with a feverish illness DISCUSSION: The PiC study will provide important information for policy makers regarding the value of POCT and on the utility and cost of emerging diagnostic strategies. The study will also identify which elements of existing CPGs may merit inclusion in any future study to derive clinical decision rules for this population.NCT03378258 . Retrospectively registered

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2018 BMC Pediatrics

18. Development of a new clinical decision rule for cervical CT to detect cervical spine injury in patients with head or neck trauma. (PubMed)

Development of a new clinical decision rule for cervical CT to detect cervical spine injury in patients with head or neck trauma. Previous cervical spine imaging decision rules have been based on positive findings on plain X-ray and are limited by lack of specificity, age restrictions and complicated algorithms. We previously derived and validated a clinical decision rule (Rule 1) for detecting cervical spine injury (CSI) on CT in a single-centre study. This recommended CT for patients with (1 (...) ) GCS score <14, (2) GCS 14-15 and posterior cervical tenderness or neurological deficit, (3) age ≥60 years and fall down stairs, or (4) age <60 and injured in a motorcycle collision or fallen from height. This study assessed the accuracy and reliability of this rule and refined the rule.We conducted a prospective, dual-centre study at two Japanese EDs between August 2012 and March 2014. Patients with head or neck injury ≥16 years of age were included. Clinical data were collected from medical

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2018 Emergency Medicine Journal

19. This Article Corrects: “GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes” (PubMed)

This Article Corrects: “GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes” [This corrects the article on p. 1108 in vol. 18, PMID: 29085544.].

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2018 Western Journal of Emergency Medicine

20. Aortic Dissection Detection-Risk Score: A Clinical Decision Rule that Needs Some Parenting. (PubMed)

Aortic Dissection Detection-Risk Score: A Clinical Decision Rule that Needs Some Parenting. 30312510 2018 11 20 1553-2712 2018 Oct 12 Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Acad Emerg Med Aortic Dissection Detection Risk Score: A Clinical Decision Rule That Needs Some Parenting. 10.1111/acem.13636 Hill Jeffery M JM University of Cincinnati College of Medicine, Cincinnati, OH. Murphy Timothy G TG University of Cincinnati College of Medicine

2018 Academic Emergency Medicine

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