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Clinical Decision Rule

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21. 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

22. 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

23. 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

24. 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

25. 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

26. A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury. (PubMed)

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

27. A Cost-Effectiveness Analysis Comparing Clinical Decision Rules PECARN, CATCH, and CHALICE With Usual Care for the Management of Pediatric Head Injury. (PubMed)

A Cost-Effectiveness Analysis Comparing Clinical Decision Rules PECARN, CATCH, and CHALICE With Usual Care for the Management of Pediatric Head Injury. To determine the cost-effectiveness of 3 clinical decision rules in comparison to Australian and New Zealand usual care: the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), the Pediatric Emergency Care Applied Research Network (PECARN), and the Canadian Assessment of Tomography for Childhood Head (...) Injury (CATCH).A decision analytic model was constructed from the Australian health care system perspective to compare costs and outcomes of the 3 clinical decision rules compared with Australian and New Zealand usual care. The study involved multicenter recruitment from 10 Australian and New Zealand hospitals; recruitment was based on the Australian Pediatric Head Injury Rules Study involving 18,913 children younger than 18 years and with a head injury, and with Glasgow Coma Scale score 13 to 15

2018 Annals of Emergency Medicine

28. 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. (PubMed)

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

29. The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review (PubMed)

The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review Risk prediction models may be valuable to identify women at risk of pre-eclampsia to guide aspirin prophylaxis in early pregnancy.To assess the performance of 'simple' risk models for pre-eclampsia that use routinely collected maternal characteristics; compare (...) specialised models. A simple model achieved fewer false positives than a guideline recommended risk factor list, but sensitivity to classify risk for aspirin prophylaxis was not assessed.Validated simple pre-eclampsia risk models demonstrate good risk discrimination that can be improved with specialised tests. Further research is needed to determine their clinical value to guide aspirin prophylaxis compared with decision rules.Pre-eclampsia risk models using maternal factors show good risk discrimination

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2016 EvidenceUpdates

30. 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 Controlled trial quality: uncertain

31. 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

32. 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.

33. A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules. (PubMed)

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules. The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical (...) decision rule for determining the necessity of radiography in wrist trauma.This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture.A total of 603 eligible trauma patients presented to the participating EDs

2016 American Journal of Emergency Medicine

34. Prospective Validation and Refinement of a Decision Rule to Obtain Chest X-ray in Patients With Nontraumatic Chest Pain in the Emergency Department

in the United States with a chief complaint of nontraumatic CP. Previously defined high-risk history and examination elements were combined into a refined decision rule and these elements were recorded for each patient by the ED physician. CXR results were reviewed and analyzed to determine the presence of clinically significant findings including pneumonia, pleural effusion, pneumothorax, congestive heart failure, or the presence of a new mass. Odds ratios for each history and examination element were (...) analyzed as well as sensitivity, specificity, and negative predictive value (NPV) of the rule overall.A total of 1,111 patients were enrolled and 1,089 CXRs were analyzed. There were 70 (6.4%) patients with clinically relevant findings on CXR. The refined decision rule had a sensitivity of 92.9% (confidence interval [CI] = 83.4%-97.3%) and specificity of 30.4% (CI = 27.6%-33.4%) to predict clinically relevant findings on CXR, with a NPV of 98.4% (CI = 96.1%-99.4%). Five CXRs with clinically significant

2018 EvidenceUpdates

35. External validation of computed tomography decision rules for minor head injury: prospective, multicentre cohort study in the Netherlands. (PubMed)

between March 2015 and December 2016.The primary outcome was any intracranial traumatic finding on CT; the secondary outcome was a potential neurosurgical lesion on CT, which was defined as an intracranial traumatic finding on CT that could lead to a neurosurgical intervention or death. The sensitivity, specificity, and clinical usefulness (defined as net proportional benefit, a weighted sum of true positive classifications) of the four CT decision rules. The rules included the CT in head injury (...) External validation of computed tomography decision rules for minor head injury: prospective, multicentre cohort study in the Netherlands. To externally validate four commonly used rules in computed tomography (CT) for minor head injury.Prospective, multicentre cohort study.Three university and six non-university hospitals in the Netherlands.Consecutive adult patients aged 16 years and over who presented with minor head injury at the emergency department with a Glasgow coma scale score of 13-15

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2018 BMJ

36. Clinical decision rules for excluding pulmonary embolism: a meta-analysis

Clinical decision rules for excluding pulmonary embolism: a meta-analysis Clinical decision rules for excluding pulmonary embolism: a meta-analysis Clinical decision rules for excluding pulmonary embolism: a meta-analysis Lucassen W, Geersing GJ, Erkens PM, Reitsma JB, Moons KG, Buller H, van Weert HC CRD summary This review concluded that clinical decision rules or Gestalt could safely exclude pulmonary embolism, when combined with sensitive D-dimer testing. Standardised decision rules were (...) recommended over Gestalt. The review was generally well conducted, but the conclusions and implications for practice seem to be too strong for the evidence presented. Authors' objectives To compare the failure rates of standard clinical assessment (Gestalt) and clinical decision rules, when used in combination with D-dimer testing, to diagnose pulmonary embolism in adults with suspected pulmonary embolism. Searching MEDLINE and EMBASE were searched for articles published in English, French, German

2011 DARE.

37. Rare adverse events in clinical trials: understanding the rule of three

Rare adverse events in clinical trials: understanding the rule of three Rare adverse events in clinical trials: understanding the rule of three | 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 Rare adverse events in clinical trials: understanding the rule of three Article Text EBM opinion and debate Rare adverse events in clinical trials: understanding the rule of three Igho J Onakpoya Statistics from Altmetric.com Investigators should

2018 Evidence-Based Medicine (Requires free registration)

38. Infant Minor Head Trauma Clinical Decision Rule

Infant Minor Head Trauma Clinical Decision Rule Infant Minor Head Trauma Clinical Decision Rule - 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. Infant Minor Head Trauma Clinical Decision Rule (PELICAN (...) : Francophone Pediatric Resuscitation and Emergency Group (GFRUP) Information provided by (Responsible Party): Assistance Publique - Hôpitaux de Paris Study Details Study Description Go to Brief Summary: The purpose of this study is to validate a clinical decision rule for the management of minor head trauma in infants aged less than two years, constructed with the intention of minimizing the rate of computed tomography scans ordering. Condition or disease Head Trauma Detailed Description: Apparently minor

2017 Clinical Trials

39. Clinical Decision Rules for Pulmonary Embolism in Hospitalized Patients: A Systematic Literature Review and Meta-analysis. (PubMed)

Clinical Decision Rules for Pulmonary Embolism in Hospitalized Patients: A Systematic Literature Review and Meta-analysis. Background Clinical decision rules (CDRs) for pulmonary embolism (PE) have been validated in outpatients, but their performance in hospitalized patients is not well characterized. Objectives The goal of this systematic literature review was to assess the performance of CDRs for PE in hospitalized patients. Methods We performed a structured literature search using Medline (...) , PE prevalence and CDR performance were extracted. The methodological quality of the studies was assessed using the QUADAS instrument. Results Twelve studies encompassing 3,942 hospitalized patients were included. Studies varied in methodology (randomized controlled trials and observational studies) and reference standards used. The pooled sensitivity of the modified Wells rule (cut-off ≤ 4) in hospitalized patients was 72.1% (95% confidence interval [CI], 63.7-79.2) and the pooled specificity

2017 Thrombosis and haemostasis

40. Petechiae In Children (PIC) Study: Defining A Clinical Decision Rule for The Management Of Fever and Non-Blanching Rashes In Children Including The Role Of Point Of Care Testing For Procalcitonin & Neisseria Meningitidis DNA.

Petechiae In Children (PIC) Study: Defining A Clinical Decision Rule for The Management Of Fever and Non-Blanching Rashes In Children Including The Role Of Point Of Care Testing For Procalcitonin & Neisseria Meningitidis DNA. Petechiae In Children (PIC) Study: Defining A Clinical Decision Rule for The Management Of Fever and Non-Blanching Rashes In Children Including The Role Of Point Of Care Testing For Procalcitonin & Neisseria Meningitidis DNA. - 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. Petechiae In Children (PIC) Study: Defining A Clinical Decision Rule for The Management Of Fever and Non-Blanching Rashes In Children Including The Role Of Point Of Care Testing For Procalcitonin & Neisseria

2017 Clinical Trials

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