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Clinical Decision Rule

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181. Comparison of quantitative electroencephalogram to current clinical decision rules for head computed tomography use in acute mild traumatic brain injury in the ED. (PubMed)

Comparison of quantitative electroencephalogram to current clinical decision rules for head computed tomography use in acute mild traumatic brain injury in the ED. We compared the performance of a handheld quantitative electroencephalogram (QEEG) acquisition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-Radiography Utilization Study II (NEXUS II) Rule in predicting intracranial lesions on head computed tomography (CT) in acute mild traumatic brain (...) intracranial lesions on head CT. Quantitative electroencephalogram discriminant score of greater than or equal to 31 was found to be a good cutoff (area under receiver operating characteristic curve = 0.84; 95% confidence interval [CI], 0.76-0.93) to classify patients with positive head CT. The sensitivity of QEEG discriminant score was 92.3 (95% CI, 73.4-98.6), whereas the specificity was 57.1 (95% CI, 48.0-65.8). The sensitivity and specificity of the decision rules were as follows: NOC 96.1 (95% CI

2014 American Journal of Emergency Medicine

182. Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas. (PubMed)

Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas. Since the diagnostic yield of chest X-ray (CXR) is not high enough, when it is ordered for all the multiple trauma patients, this study was aimed to evaluate the relationship between clinical and CXR findings in order to formulate a clinical decision rule to prevent unnecessary CXR in these patients.Stable multiple blunt trauma patients referring to the ED were included. The clinical (...) and radiographic findings of all the patients were collected and the relationships between these variables analysed. Finally, based on the regression coefficients (β) of the variables, the Thoracic Injury Rule-out Criteria (TIRC) were designed.A total of 2607 patients were included (males: 78.9%, mean age: 34.1 ± 15.0 years). Age over 60 (β = 0.8; 95% CI: 0.27-1.34; P = 0.003), crepitation (β = 4.33; 95% CI: 1.65-7.0; P < 0.001), loss of consciousness (β = 3.16; 95% CI: 2.44-3.88; P < 0.001), decrease

2014 Emergency medicine Australasia

183. External validation of the Ottawa subarachnoid hemorrhage clinical decision rule in patients with acute headache. (PubMed)

External validation of the Ottawa subarachnoid hemorrhage clinical decision rule in patients with acute headache. We aim to externally validate the Ottawa subarachnoid hemorrhage (OSAH) clinical decision rule. This rule identifies patients with acute nontraumatic headache who require further investigation. We conducted a medical record review of all patients presenting to the emergency department (ED) with headache from January 2011 to November 2013. Per the OSAH rule, patients with any (...) of the following predictors require further investigation: age 40 years or older, neck pain, stiffness or limited flexion, loss of consciousness, onset during exertion, or thunderclap. The rule was applied following the OSAH rule criteria. Patients were followed up for repeat visits within 7 days of initial presentation. Data were electronically harvested from the electronic medical record and manually abstracted from individual patient charts using a standardized data abstraction form. Calibration between

2014 American Journal of Emergency Medicine

184. Sensitivity of proposed clinical decision rules for subarachnoid haemorrhage: An external validation study. (PubMed)

Sensitivity of proposed clinical decision rules for subarachnoid haemorrhage: An external validation study. Subarachnoid haemorrhage (SAH) is an uncommon but important cause of sudden-onset headache. Three clinical decision rules (CDRs) for investigation in sudden headache have been proposed, but concerns were raised about the generalisability of some variables. Our aim was to determine what proportion of patients with confirmed SAH has the identified high-risk factors and the sensitivity (...) interval [CI] 88.5-99.1%), sensitivity of proposed CDR 2 was 100% (95% CI 93.9-100%) and sensitivity of proposed CDR 3 was 89.8% (95% CI 79.5-95.3%). The addition of vomiting to the criteria in CDRs 1 and 3 increased the sensitivity of both these CDRs to 100%.CDR 2, or the refinement of CDRs 1 and 3 with the inclusion of at least one episode of vomiting as a criterion, has very high sensitivity. Although unlikely to reduce CT scan rates for patients in whom there is a clinical suspicion of SAH

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2014 Emergency medicine Australasia

185. Prediction of bacteremia in the emergency department: an external validation of a clinical decision rule. (PubMed)

Prediction of bacteremia in the emergency department: an external validation of a clinical decision rule. The objective of this study was to validate a previously published clinical decision rule for predicting a positive blood culture in emergency department (ED) patients with suspected infection on the basis of major and minor criteria and a total score (Shapiro et al., J Emerg Med, 2008; 35:255-264).This is a retrospective matched cohort study of adult ED patients with blood cultures (...) obtained from 1 January 2011 through to 31 December 2011. ED patients with blood culture-confirmed bacteremia were matched 1 : 3 with patients with negative cultures. The outcome was 'true bacteremia'. Data on clinical history, comorbid illnesses, physical observations, and laboratory tests were used to evaluate the application of the clinical decision rule. We report the sensitivity, specificity, and area under the curve.Among 1526 patients, 105 (6.9%) patients were classified with true bacteremia

2014 European Journal of Emergency Medicine

186. A novel approach to the determination of clinical decision thresholds

and Swiss physicians that may be a function of differences in healthcare systems. Our results can also guide development of clinical decision rules and guidelines. Acknowledgments The authors would like to thank the physicians who took the time to complete our survey, in particular the members of the Swiss Sentinella Network. Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You (...) A novel approach to the determination of clinical decision thresholds A novel approach to the determination of clinical decision thresholds | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username

2015 Evidence-Based Medicine (Requires free registration)

187. Spinal Injections Coverage Decision

and/or anesthetic into the spine or space around the spinal nerves and joints. This coverage decision describes the purpose of each type of injection and addresses the criteria required for authorization. The criteria for allowing these injections are based on L&I’s Medical Aid Rules (WACs) and decisions of the statutory Health Technology Clinical Committee (HTCC). Decisions of the HTCC are mandatory for state agencies. Hyperlinks to the basis for these decisions are in a coverage table at the end (...) of at least 6 weeks of conservative therapy. 3. Fluoroscopic or CT guidance is used. 4. No more than one injection without clinically meaningful improvement, as documented by a validated scale. Additional injections require clinical review. * For therapeutic sacroiliac injections, this coverage decision does not apply to those with a known systemic inflammatory disease such as ankylosing spondylitis, psoriatic arthritis or enteropathic arthritis. Intradiscal Injections Therapeutic intradiscal injections

2019 Washington State Department of Labor and Industries

188. Computed tomography to rule out suspected appendicitis in adults and reduce the negative appendectomy rate

assessed five studies; two systematic reviews with meta-analyses and three non-randomised comparative studies. The results of the two systematic reviews confirm that CT, even when performed without contrast agents, yields high diagnostic accuracy, adequate for clinical decision making. In general, CT was found to lower negative appendectomy rate (NAR), and increase time to surgery. The effect of delaying surgery is inconsistent with one systematic review stating it did not negatively impact (...) associated with CT. One systematic review found CT in adults to be justified if radiation exposure is considered in the clinical decision pathway. Two of the non-randomised comparative studies supported a shift away from routine CT to diagnose appendicitis via the routine use of MRI or laparoscopy. This was, in part, owing to a reduction in the risks associated with abdominal and pelvic radiation (particularly in children and women of childbearing age). It is important to note that Choosing Wisely

2016 COAG Health Council - Horizon Scanning Technology Briefs

189. Tiny Tips: Canadian CT Head Rule

for patients with minor head injury. 1 In 2010, a multi-centre prospective trial implemented the CCHR and found that the rate of CT imaging increased despite the use of the clinical decision rule. 2 Of the many factors influencing this, the greatest seems to be that clinicians inappropriately apply the CCHR and may be unfamiliar with the inclusion and exclusion criteria. Of note, only head injury patients with a witnessed loss of consciousness (LOC), definite amnesia, or witnessed disorientation (...) . Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med . 2012;19(1):2-10. [ ] Reviewing with the Staff The Canadian CT Head Rule is a safe and helpful rule to assess head injury patients to determine which patients require imaging. However, as with all clinical decision rules/scores, it needs to be applied correctly. Only apply this rule to patients with head

2016 CandiEM

190. Two simple questions help GPs rule out depression

Two simple questions help GPs rule out depression Two simple questions help GPs rule out depression Discover Portal Discover Portal Two simple questions help GPs rule out depression Published on 23 March 2016 doi: The Whooley questions are useful for ruling out depression in that few people who answer no to both questions are depressed according to a ‘gold standard’ diagnostic interview. A positive screen is indicated by the person answering “yes” to one or both of the Whooley questions (...) to little harm. In terms of the ability of the test to rule out or rule in depression the pooled positive likelihood ratio of 2.78 (95% CI 2.16 to 3.57) and the pooled negative likelihood ratio of 0.07 (95% CI 0.03 to 0.16) mean that the questions are best at ruling out depression. In the setting of general practice, with less than 20% prevalence of depression, a negative result on the questions (two no’s) effectively means the chance of having depression is reduced from 20% to less than 2%. There were

2018 NIHR Dissemination Centre

191. Tiny Tip: The Ottawa Ankle and Foot Rules – To Image or Not to Image

this decision. The Ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in Emergency Departments. Ottawa Ankle and Foot Rules The rules are as follows: An ankle radiographic series is only required if there is any pain in the malleolar zone and any of these findings: Bone tenderness at A Bone tenderness at B Inability to bear weight both immediately and in the emergency department A foot radiographic series is only required if there is any pain (...) for determining who might need an ankle x-ray - I just hope I only have to remember it and not have to actually sing it - that would be bad! One other clinical tip is that the Ottawa Ankle Rules have been validated in children[3,4,5] and it is completely okay to use it in these little adults. Not everyone remembers that. Dr. Lisa Thurgur Dr. Thurgur is an Emergency Physician at The Ottawa Hospital, and an Assistant Professor at University of Toronto. (Visited 5,912 times, 7 visits today) Maeghan Fu Maeghan Fu

2016 CandiEM

192. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis

Systematic Reviews Ltd, York, UK 2 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands 3 Health Economics and Decision Science Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK 4 Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 5 School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht (...) High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404

2015 NIHR HTA programme

193. Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules (PubMed)

Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules Clinical decision rules (CDRs) could be helpful to safely distinguish between bacterial and aseptic meningitis (AM).To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest.Secondary analysis of retrospective multicentre hospital-based cohort study.Six paediatric emergency or intensive care units of tertiary care (...) for the sensitivity of both rules, which can be used cautiously. However, use of the BMS could safely avoid significantly more unnecessary antibiotic treatments for children with AM than can the Meningitest in this population.

2011 EvidenceUpdates

194. Clinical decision rules for adults with minor head injury: a systematic review (PubMed)

Clinical decision rules for adults with minor head injury: a systematic review There are many clinical decision rules for adults with minor head injury, but it is unclear how they compare in terms of diagnostic accuracy. This study aimed to systematically identify clinical decision rules for adults with minor head injury and compare the estimated diagnostic accuracies for any intracranial injury and injury requiring neurosurgical intervention.Several electronic bibliographic databases covering (...) biomedical, scientific, and gray literature were searched from inception to March 2010. At least two independent reviewers determined the eligibility of cohort studies that described a clinical decision rule to identify adults with minor head injury (Glasgow Coma Scale score, 13-15) at risk of intracranial injury or injury requiring neurosurgical intervention.Twenty-two relevant studies were identified. Differences existed in patient selection, outcome definition, and reference standards used. Nine rules

2011 EvidenceUpdates

195. Clinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis. (PubMed)

Clinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis. Clinical probability assessment is combined with d-dimer testing to exclude pulmonary embolism (PE).To compare the test characteristics of gestalt (a physician's unstructured estimate) and clinical decision rules for evaluating adults with suspected PE and assess the failure rate of gestalt and rules when used in combination with d-dimer testing.Articles in MEDLINE and EMBASE in English, French, German, Italian, Spanish (...) , or Dutch that were published between 1966 and June 2011.3 reviewers, working in pairs, selected prospective studies in consecutive patients suspected of having PE. Studies had to estimate the probability of PE by using gestalt or a decision rule and verify the diagnosis by using an appropriate reference standard.Data on study characteristics, test performance, and prevalence were extracted. Reviewers constructed 2 × 2 tables and assessed the methodological quality of the studies.52 studies, comprising

2011 Annals of Internal Medicine

196. Clinical decision rules for children with minor head injury: a systematic review (PubMed)

Clinical decision rules for children with minor head injury: a systematic review Clinical decision rules aid clinicians with the management of head injured patients. This study aimed to identify clinical decision rules for children with minor head injury and compare their diagnostic accuracy for detection of intracranial injury (ICI) and injury requiring neurosurgical intervention (NSI).Relevant studies were identified by an electronic search of key databases. Papers in English were included (...) consistent (sensitivity 98%; specificity 58%). For neurosurgical injury all had high sensitivity (98-100%) but the children's head injury algorithm for the prediction of important clinical events (CHALICE) rule had the highest specificity (86%) in its derivation cohort.Of the current decision rules for minor head injury the PECARN rule appears the best for children and infants, with the largest cohort, highest sensitivity and acceptable specificity for clinically significant ICI. Application of this rule

2011 EvidenceUpdates

197. Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism: A Prospective Cohort Study. (PubMed)

Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism: A Prospective Cohort Study. Several clinical decision rules (CDRs) are available to exclude acute pulmonary embolism (PE), but they have not been directly compared.To directly compare the performance of 4 CDRs (Wells rule, revised Geneva score, simplified Wells rule, and simplified revised Geneva score) in combination with d-dimer testing to exclude PE.Prospective cohort study.7 hospitals (...) Wells rule) to 72% (Wells rule). Combined with a normal d-dimer result, the CDRs excluded PE in 22% to 24% of patients. The total failure rates of the CDR and d-dimer combinations were similar (1 failure, 0.5% to 0.6% [upper-limit 95% CI, 2.9% to 3.1%]). Even though 30% of patients had discordant CDR outcomes, PE was not detected in any patient with discordant CDRs and a normal d-dimer result.Management was based on a combination of decision rules and d-dimer testing rather than only 1 CDR combined

2011 Annals of Internal Medicine

198. Randomised controlled trial: Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing

Randomised controlled trial: Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log (...) in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing Article Text Quality

2014 Evidence-Based Medicine (Requires free registration)

199. Can emergency physicians safely rule in or rule out pediatric intussusception in the Emergency Department using bedside ultrasound?

, however, were much lower (85–89% with wide CI), which seems clinically unacceptable when a diagnosis with such possible dismal consequences is suspected. Both studies were based on relatively small size resulting in large CI making the final decision difficult. Editor Comment ED, emergency department; EP, emergency physician; LR, likelihood ratio; NPV, negative predictive value; PPV, positive predictive value; USS, ultrasound scan. Clinical Bottom Line ED bedside ultrasound could possibly be used (...) Can emergency physicians safely rule in or rule out pediatric intussusception in the Emergency Department using bedside ultrasound? BestBets: Can emergency physicians safely rule in or rule out pediatric intussusception in the Emergency Department using bedside ultrasound? Can emergency physicians safely rule in or rule out pediatric intussusception in the Emergency Department using bedside ultrasound? Report By: Éliane Raymond-Dufresne - PGY-3, Emergency Medicine Search checked by Hisham

2013 BestBETS

200. "I Never Would Have Caught That Before": Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States. (PubMed)

"I Never Would Have Caught That Before": Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States. To systematically improve the appropriateness of antibiotic prescribing, antimicrobial stewardship programs have been developed. There is a paucity of literature examining how pharmacists perform antimicrobial stewardship using a clinical decision support system in a hospital setting. The purpose of this qualitative study was to develop a model (...) exploring how pharmacists perform antimicrobial stewardship to identify areas for programmatic improvement. Semistructured interviews were conducted across a health care system until saturation of themes was reached. Pharmacists identified that self-efficacy and time were vital for antimicrobial stewardship to be performed, while culture of the hospital and attitude facilitated the process of stewardship. Antimicrobial stewardship programs using clinical decision support tools should ensure pharmacists

2018 Qualitative Health Research

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