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Clinical Decision Rule

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1. Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines

Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines | CADTH.ca Find the information you need Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines Clinical Decision Rules and Strategies (...) for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines Last updated: May 23, 2018 Project Number: RC0982-000 Product Line: Research Type: Other Diagnostics Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical utility of clinical decision rules for the initial screening of patients with suspected group A strep infection? What are the evidence-based guidelines regarding the diagnosis of suspected group A strep infection? Key

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

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

"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. Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department Full Text available with Trip Pro

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

2018 EvidenceUpdates

4. Bacterial meningitis in Sudanese children; critical evaluation of the clinical decision using clinical prediction rules. Full Text available with Trip Pro

Bacterial meningitis in Sudanese children; critical evaluation of the clinical decision using clinical prediction rules. Sudan falls in the meningitis belt where most global cases of bacterial meningitis are reported. Highly accurate decision support tools have been developed by international specialized societies to guide the diagnosis and limit unnecessary hospital admissions and prolonged antibiotic use that have been frequently reported from countries around the world. The goals (...) of this study are to critically evaluate the clinical decision of bacterial meningitis in children in Sudan using clinical prediction rules and to identify the current bacterial aetiology.This cross-sectional hospital-based study was conducted in October to July of 2010 in a major referral pediatric hospital in Khartoum, Sudan. Febrile children age 1 day to 15 years who were provisionally diagnosed as having meningitis on admission were included (n = 503). Cerebrospinal fluid (CSF) specimens were obtained

2019 BMC Pediatrics

5. An impact analysis of the NEXUS Chest CT clinical decision rule. (Abstract)

An impact analysis of the NEXUS Chest CT clinical decision rule. The NEXUS Chest CT clinical decision rules (CDRs) have been proposed to safely guide selective chest CT use in blunt trauma evaluation. We conducted a cost-effectiveness analysis of the NEXUS Chest CT CDR to determine its impact on missed injuries, cost, and radiation exposure.We constructed a decision model comparing two strategies: implementation of the NEXUS Chest CDR vs. usual care in the evaluation of adults with blunt trauma (...) . We derived probabilities, clinical outcomes, effective radiation dose (ERD) from the NEXUS Chest CT validation cohort and costs from the Charge-master at the primary study site. Our primary outcomes were cost and effective radiation dose (ERD) per missed clinically significant injury (CSI).Using a hypothetical cohort of 1000 adults with blunt chest trauma in each arm, the base case model projected that the implementation of the CDR would result in 161 fewer chest CTs, 0.08 additional missed CSIs

2019 American Journal of Emergency Medicine

6. Clinical decision rule for non-traumatic computed tomography of the brain. (Abstract)

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

7. Validation and impact of a simplified clinical decision rule for diagnosing pulmonary embolism in primary care: design of the PECAN prospective diagnostic cohort management study. Full Text available with Trip Pro

Validation and impact of a simplified clinical decision rule for diagnosing pulmonary embolism in primary care: design of the PECAN prospective diagnostic cohort management study. Combined with patient history and physical examination, a negative D-dimer can safely rule-out pulmonary embolism (PE). However, the D-dimer test is frequently false positive, leading to many (with hindsight) 'unneeded' referrals to secondary care. Recently, the novel YEARS algorithm, incorporating flexible D-dimer

2019 BMJ open

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

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

9. 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 Full Text available with Trip Pro

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

2017 EvidenceUpdates

10. External validation of a clinical decision rule: we need events in a population in order to rule them out! Full Text available with Trip Pro

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.

2017 Scandinavian journal of trauma, resuscitation and emergency medicine

11. How Accurate are Clinical Decision Rules for Pediatric Minor Head Injury?

How Accurate are Clinical Decision Rules for Pediatric Minor Head Injury? SystematicReviewSnapshot TAKE-HOME MESSAGE The Pediatric Emergency Care Applied Research Network (PECARN) decision rule is very sensitive for detecting clinically important brain injury in children with minor head trauma. METHODS DATA SOURCES Investigators searched MEDLINE (to March 2010), EMBASE, CINAHL, and CENTRAL (to April 2009), the Web of Knowledge’s Science Citation In- dex, Social Science Citation Index (...) studies. Al- though the investigators planned to perform a meta-analysis of rules that were independently validated, only a systematic review without pooling results was feasible. How Accurate Are Clinical Decision Rules for Pediatric Minor Head Injury? EBEM Commentators Kelly Medwid, MD New York University School of Medicine/Bellevue Hospital Center Department of Emergency Medicine New York, NY Gene G. Couri, MD OSF Saint Francis Medical Center Peoria, IL Results Of the 14 cohorts studying children

2012 Annals of Emergency Medicine Systematic Review Snapshots

12. Systematic review: diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly

Systematic review: diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.

2012 DARE.

13. Utility of Clinical and Laboratory Decision Rules in Identifying Bacterial Meningitis Among Children With suspicion of Central Nervous System Infections in a Malaria-Endemic Area, Mbarara Uganda. (Abstract)

Utility of Clinical and Laboratory Decision Rules in Identifying Bacterial Meningitis Among Children With suspicion of Central Nervous System Infections in a Malaria-Endemic Area, Mbarara Uganda. Several decision rules combining clinical and biological parameters have been proposed to distinguish bacterial from aseptic meningitis, but have not been evaluated in Africa. In children hospitalized with suspected central nervous system infections in Uganda, we found that the Bacterial Meningitis (...) Score and Meningitest showed lower performance than in European children, and that a decision rule designed specifically using parameters associated with bacterial meningitis also showed inadequate diagnostic performance for clinical use.

2018 Pediatric Infectious Dsease Journal

14. Best practices for preventing malfunctions in rule-based clinical decision support alerts and reminders: Results of a Delphi study. Full Text available with Trip Pro

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

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

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

16. A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury. Full Text available with Trip Pro

A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury. OBJECTIVEWhile existing guidelines support the treatment of intracranial hypertension in severe traumatic brain injury (TBI), it is unclear when to suspect and initiate treatment for high intracranial pressure (ICP). The objective of this study was to derive a clinical decision rule that accurately predicts intracranial hypertension.METHODSUsing Delphi methods, the authors identified a set (...) of potential predictors of intracranial hypertension and a clinical decision rule a priori by consensus among a group of 43 neurosurgeons and intensivists who have extensive experience managing severe TBI without ICP monitoring. To validate these predictors, the authors used data from a Latin American trial (n = 150; BEST TRIP). To report on the performance of the rule, they calculated sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals. In a secondary

2018 Journal of Neurosurgery

17. This Article Corrects: “GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes” Full Text available with Trip Pro

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.].

2018 Western Journal of Emergency Medicine

18. Acceptability of a Mobile Clinical Decision Tool Among Emergency Department Clinicians: Development and Evaluation of The Ottawa Rules App Full Text available with Trip Pro

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

2018 JMIR mHealth and uHealth

19. Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil? Full Text available with Trip Pro

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

2018 Singapore medical journal

20. Clinical decision rules in emergency care Full Text available with Trip Pro

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

2018 Singapore medical journal

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