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Clinical Decision Rule

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181. Performance of pre-hospital evaluations in ruling out invasive chest stab wounds. Full Text available with Trip Pro

Performance of pre-hospital evaluations in ruling out invasive chest stab wounds. Some guidelines advocate for managing patients with penetrating thoracic wounds in trauma centres with cardiothoracic surgery. This systematic approach is questionable. Only 15% of these patients require surgery. It is known that clinical examination fails to detect hemopneumothorax in penetrating trauma. However, no studies have evaluated the combined diagnostic performance of vital signs and the clinical (...) evaluation of wounds. The clinical characteristics of wounds have not been investigated. We aimed to evaluate the ability of combinations of pre-hospital signs to rule out invasive chest stab trauma.This was a prospective observational study. All consecutive adult patients hospitalized in the perioperative acute care unit of a tertiary university hospital were included. Injury diagnoses were provided by exploratory surgery and imaging tests. Patients with a final diagnosis of invasive wounds (IWs

2020 Scandinavian journal of trauma, resuscitation and emergency medicine

182. FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients. Full Text available with Trip Pro

and that it served as a reliable prediction rule for 30-day mortality in FluA-p patients. The score could also effectively stratify FluA-p patients into relevant risk categories and thereby help treatment providers to make more rational clinical decisions. (...) FluA-p score: a novel prediction rule for mortality in influenza A-related pneumonia patients. The pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) score have been shown to predict mortality in community-acquired pneumonia. Their ability to predict influenza-related pneumonia, however, is less well-established.A total of 693 laboratory-confirmed FluA-p patients diagnosed between Jan 2013 and Dec 2018 and recruited from five

2020 Respiratory research

183. To CT, or not to CT? Clinical Decision Rules for Concussion

To CT, or not to CT? Clinical Decision Rules for Concussion To CT, or not to CT? Clinical Decision Rules for Concussion | Cochrane Child Health Passionate about Cochrane evidence for kids! Search Main menu Post navigation by May 11, 2015 – This week’s blog post is also available from (Translating Emergency Knowledge for Kids). Attribution: Wikimedia Commons Head trauma. Headache. Nausea. Loss of balance. Dizziness. Difficulty concentrating. Confusion. Behavioural changes. Sleep changes (...) it is linked to better outcomes, lower admission rates, and serves as the diagnostic standard for identifying intracranial injury ( ). However, it isn’t feasible or necessary to conduct this scan with all children presenting with concussion symptoms. This makes a clinical decision rule for CT scans important. With summer around the corner, and team sports ramping up for the season, understanding and using effective and validated clinical decision rules is essential to identify children at risk

2015 Cochrane Child Health Blog

184. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

patients to the risk of radiation. Biomarkers, in combination with clinical decision tools, could help to rule out intracranial injuries without CT investigations, saving CT use for those most at risk and thus, minimising unnecessary radiation exposure and resource use. METHODS A systematic review was performed to assess the diagnostic accuracy and economic value of biomarkers compared to CT scan, for intracranial injuries (ICI) in adults and children with mCT. RESULTS Most of the available evidence (...) ) scanning is used only in mCT patients whom clinicians assess as being at risk of intracranial lesions either on the basis of clinical decision rules and/or unstructured assessments a . CT scan is currently recognised as the gold standard b for diagnosis of ICI because of its wide availability and its sensitivity for intracranial lesions linked to cranial trauma. Nevertheless, it is an expensive procedure that exposes patients to the risk of radiation, making it important to carefully assess the need

2016 Belgian Health Care Knowledge Centre

185. Prescriptive clinical prediction rules used to guide foot orthotic management of musculoskeletal conditions: a systematic review and meta-analysis

Prescriptive clinical prediction rules used to guide foot orthotic management of musculoskeletal conditions: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith (...) therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we will attempt to contact authors

2018 PROSPERO

186. Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma [Cochrane protocol]

Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma [Cochrane protocol] Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites (...) . No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we

2018 PROSPERO

187. Clinical prediction rules for the diagnosis of asthma in primary care: a systematic review

Clinical prediction rules for the diagnosis of asthma in primary care: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address (...) in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we will attempt to contact authors by e-mail (max. 2 attempts). In case an outcome is measured

2018 PROSPERO

188. External Validation of the Manchester Acute Coronary Syndromes Decision Rule. Full Text available with Trip Pro

at presentation to the ED. The objective was to externally validate the MACS decision rule and establish its diagnostic accuracy as a discharge tool in a new set of prospectively recruited ED patients.In this preplanned analysis of a prospectively recruited single-center cohort, consecutive ED patients ≥18 years with suspected ACS were included. Testing for h-FABP and high-sensitivity troponin T was undertaken on serum drawn on arrival, and any clinical features required to calculate the MACS rule were (...) External Validation of the Manchester Acute Coronary Syndromes Decision Rule. The Manchester Acute Coronary Syndromes (MACS) decision rule has been shown to be a powerful diagnostic tool in emergency department (ED) patients with suspected acute coronary syndromes (ACS). It has the potential to improve system efficiency by identifying patients suitable for discharge after a single blood draw for high-sensitivity troponin and heart-type fatty acid-binding protein (h-FABP) analysis

2016 Academic Emergency Medicine

189. Prediction of Early Recurrence of Liver Cancer by a Novel Discrete Bayes Decision Rule for Personalized Medicine Full Text available with Trip Pro

JIS, and the TNM classification have been proposed as liver scoring systems, none of these scoring systems have met the needs of clinical practice. In this paper, we convert continuous and discrete data to categorical data and keep the natively categorical data as is. Then, we propose a discrete Bayes decision rule that can deal with the categorical data. This may lead to its use with various types of laboratory data. Experimental results show that the proposed method produced a sensitivity (...) Prediction of Early Recurrence of Liver Cancer by a Novel Discrete Bayes Decision Rule for Personalized Medicine We discuss a novel diagnostic method for predicting the early recurrence of liver cancer with high accuracy for personalized medicine. The difficulty with cancer treatment is that even if the types of cancer are the same, the cancers vary depending on the patient. Thus, remarkable attention has been paid to personalized medicine. Unfortunately, although the Tokyo Score, the Modified

2016 BioMed research international

190. Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma Full Text available with Trip Pro

Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma Thoracic injury rule out criteria (TIRC) were first introduced as a decision instrument for selective chest radiography in blunt thoracic trauma in 2014. However, the validity of this model has not been assessed in other studies. In this regard, the present survey evaluates the validity of TIRC model in a multi-center setting.In this cross-sectional study (...) , clinical presentations and chest radiograms of multiple trauma patients referring to 6 educational hospitals in Iran were evaluated. Data were gathered prospectively during 2015. In each center, data collection and interpretation of radiograms were conducted by two different emergency medicine specialists. Measures were then taken for assessment of discriminatory power and calibration of the model.Data from 2905 patients were gathered (73.17% were male; the mean age was 33.53 ± 15.42 years). Area under

2016 Journal of clinical orthopaedics and trauma

191. Creating a Diagnostic Decision Rule for Shoulder Injury: CASH-trial

Sponsor: Zaans Medisch Centrum Information provided by (Responsible Party): K. Rijsbergen, Zaans Medisch Centrum Study Details Study Description Go to Brief Summary: What combination of ≤ 6 clinical variables will give the highest specificity for indicating significant shoulder injuries (fractures or dislocations) with a set sensitivity of ≥ 97%? Although shoulder trauma is a common injury, there is no clinical decision rule to determine the necessity for radiography for these traumas. With this trial (...) the investigators aim to develop such a rule to reduce the amount of radiographs without missing any significant injuries. The primary objective is to compose a set of clinical diagnostic criteria predictive of shoulder fractures or dislocations that would reduce the amount of radiographs without missing any significant injuries. A second objective is to determine if the clinical decision rule is applicable for triage use. Condition or disease Intervention/treatment Phase Trauma Other: Standard diagnostic item

2016 Clinical Trials

192. Utility of Decision Rules for Transcutaneous Bilirubin Measurements. Full Text available with Trip Pro

Utility of Decision Rules for Transcutaneous Bilirubin Measurements. Transcutaneous bilirubin (TcB) meters are widely used for screening newborns for jaundice, with a total serum bilirubin (TSB) measurement indicated when the TcB value is classified as "positive" by using a decision rule. The goal of our study was to assess the clinical utility of 3 recommended TcB screening decision rules.Paired TcB/TSB measurements were collected at 34 newborn nursery sites. At 27 sites (sample 1), newborns (...) were routinely screened with a TcB measurement. For sample 2, sites that typically screen with TSB levels also obtained a TcB measurement for the study. Three decision rules to define a positive TcB measurement were evaluated: ≥75th percentile on the Bhutani nomogram, 70% of the phototherapy level, and within 3 mg/dL of the phototherapy threshold. The primary outcome was a TSB level at/above the phototherapy threshold. The rate of false-negative TcB screens and percentage of blood draws avoided

2016 Pediatrics

193. Comparison of four decision aids for the early diagnosis of acute coronary syndromes in the emergency department Full Text available with Trip Pro

Berg et al. Am J Emerg Med 36 (4), 602-607. Apr 2018. PMID 29079376. Both MACS and T-MACS effectively ruled out ACS even with a contemporary troponin I assay and could be used to reduce unnecessary hospital admissions. R Body et al. Emerg Med J 34 (6), 349-356. Jun 2017. PMID 27565197. T-MACS could 'rule out' ACS in 40% of patients, while 'ruling in' 5% at highest risk using a single hs-cTnT measurement on arrival. As a clinical decision aid, T-MACS cou … R Body. Turk J Emerg Med 18 (3), 94-99 (...) Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK. 3 Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK. 4 Departments of Clinical Blood Sciences and Cardiology, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK. PMID: 31767674 DOI: Item in Clipboard Comparison of Four Decision Aids for the Early Diagnosis of Acute Coronary Syndromes in the Emergency Department Richard Body et al. Emerg Med J

2020 EvidenceUpdates

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

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

195. Methodologic Standards for Interpreting Clinical Decision Rules in Emergency Medicine: 2014 Update. (Abstract)

Methodologic Standards for Interpreting Clinical Decision Rules in Emergency Medicine: 2014 Update. Clinical decision rules are increasingly prominent in medicine, particularly in emergency care. The quality, use, and impact of current published decision rules widely vary, requiring clinicians to be critical consumers. We present an approach to assist in the appraisal of clinical decision rules and in judging when to use such rules. Copyright © 2014 American College of Emergency Physicians

2014 Annals of Emergency Medicine

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

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

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

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

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

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

2014 Emergency medicine Australasia

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

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

200. Editor’s picks: Clinical prediction rules: Use the babies and throw the bathwater?

to maintain autonomy in decision-making. That is, participants wanted a CPR to guide their decision-making, not dictate a course of action. You might call this the “I’m not a robot, don’t tell me what to do” effect, which I think raises a nice question: How then do these tools ideally fit within our practice? Despite the HIGHLY unfortunate nomenclature, clinical prediction RULES probably shouldn’t be considered rules at all (at least not in the dictatorial sense – perhaps in the statistical sense (...) of development of prediction models for primary care physical therapy: a systematic review. Journal of Clinical Epidemiology. 2012;65(12):1257-1266. [3] Stiell IG, Bennett C. Implementation of Clinical Decision Rules in the Emergency Department. Academic Emergency Medicine. 2007;14(11):955-959. [4] Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet. 2011;378(9802):1560

2018 Body in Mind blog

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