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Clinical Decision Rule

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61. The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses (PubMed)

The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses Treatment failure rates for incision and drainage (I&D) of skin abscesses have increased in recent years and may be attributable to an increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Previous authors have described sonographic features of abscesses, such as the presence of interstitial fluid (...) , characteristics of abscess debris, and depth of abscess cavity. It is possible that the sonographic features are associated with MRSA and can be used to predict the presence of MRSA. The authors describe a potential clinical decision rule (CDR) using sonographic images to predict the presence of CA-MRSA.This was a pilot CDR derivation study using databases from two emergency departments (EDs) of patients presenting to the ED with uncomplicated skin abscesses who underwent I&D and culture of the abscess

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2014 EvidenceUpdates

62. Efficacy and Safety of Outpatient Treatment Based on the Hestia Clinical Decision Rule With or Without NT-proBNP Testing in Patients With Acute Pulmonary Embolism: A Randomized Clinical Trial. (PubMed)

Efficacy and Safety of Outpatient Treatment Based on the Hestia Clinical Decision Rule With or Without NT-proBNP Testing in Patients With Acute Pulmonary Embolism: A Randomized Clinical Trial. Outpatient treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce.To validate the utility and safety of selecting patients with PE for outpatient treatment (...) three patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.65).Outpatient treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events. Given the low number of patients with elevated NT-proBNP levels, this trial was unable to draw definite conclusions regarding the incremental value of NT-proBNP testing in patients who fulfill the Hestia criteria. Clinical trial registered with www.trialregister.nl/trialreg/admin

2016 American Journal of Respiratory and Critical Care Medicine Controlled trial quality: predicted high

63. Clinical decision rules for acute bacterial meningitis: current insights (PubMed)

Clinical decision rules for acute bacterial meningitis: current insights Acute community-acquired bacterial meningitis (BM) requires rapid diagnosis so that suitable treatment can be instituted within 60 minutes of admitting the patient. The cornerstone of diagnostic examination is lumbar puncture, which enables microbiological analysis and determination of the cerebrospinal fluid (CSF) cytochemical characteristics. However, microbiological testing is not sufficiently sensitive to rule out (...) available; however, they only define a clinical probability, and in addition, their use calls for prior validation on the population in which they are used. In this article, we review current methods of BM diagnosis.

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2016 Open access emergency medicine : OAEM

64. The Cape Town Clinical Decision Rule for Streptococcal Pharyngitis in Children. (PubMed)

The Cape Town Clinical Decision Rule for Streptococcal Pharyngitis in Children. Existing clinical decision rules (CDRs) to diagnose group A streptococcal (GAS) pharyngitis have not been validated in sub-Saharan Africa. We developed a locally applicable CDR while evaluating existing CDRs for diagnosing GAS pharyngitis in South African children.We conducted a prospective cohort study and enrolled 997 children 3-15 years of age presenting to primary care clinics with a complaint of sore throat (...) , and whose parents provided consent. Main outcome measures were signs and symptoms of pharyngitis and a positive GAS culture from a throat swab. Bivariate and multivariate analyses were used to develop the CDR. In addition, the diagnostic effectiveness of 6 existing rules for predicting a positive culture in our cohort was assessed.A total of 206 of 982 children (21%) had a positive GAS culture. Tonsillar swelling, tonsillar exudates, tender or enlarged anterior cervical lymph nodes, absence of cough

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2016 Pediatric Infectious Dsease Journal

65. Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma. (PubMed)

Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma. To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma.We integrated the Epic(®) electronic health record (EHR (...) ) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed

2016 International journal of medical informatics

66. Clinical Decision Rule

Clinical Decision Rule Clinical Decision Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Clinical Decision Rule Clinical Decision (...) Rule Aka: Clinical Decision Rule , Decision Support Techniques , Clinical Prediction Rule , Decision Aids II. Indications Risk stratification for the evaluation and management of presentations with risk of poor outcome Limit testing that would otherwise risk adverse effects (e.g. radiation exposure) Standardize the approach to common conditions (esp. for those with less experience) Checklist documentation to prevent errors III. Precautions: Pitfalls Clinical Decision Rules may be misapplied Use

2018 FP Notebook

67. A systematic review of clinical decision rules for epilepsy. (PubMed)

A systematic review of clinical decision rules for epilepsy. Clinical decision rules (CDRs) have been empirically demonstrated to improve patient satisfaction and enhance cost-effective care. The use of CDRs has not yet been robustly explored for epilepsy. We performed a systematic review of MEDLINE (from 1946) and Embase (from 1947) using Medical Subject Headings and keywords related to CDRs and epilepsy. We included original research of any language deriving, validating, or implementing a CDR (...) been developed to guide their use. Future CDRs should address common clinical scenarios such as efficient use of diagnostic tools and optimal clinical treatment decisions. Given their potential for advancing efficient, evidence-based, patient-centered healthcare, CDR development should be a priority in epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

2016 Epilepsy & behavior : E&B

68. New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study. (PubMed)

New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study. To ensure good outcomes in the management of subarachnoid haemorrhage (SAH), accurate prediction is crucial for initial assessment of patients presenting with acute headache. We conducted this study to develop a new clinical decision rule using only objectively measurable predictors to exclude SAH, offering higher specificity than the previous Ottawa SAH Rule while (...) were enrolled in this study, of whom 277 showed SAH. Using these enrolled patients, we reached a rule with mainly categorical predictors used in previous reports, called the 'Ottawa-like rule', offering 100% sensitivity when using any of age ≥40 years, neck pain or stiffness, altered level of consciousness or onset during exertion. Using the 1317 patients from whom blood samples were obtained, a new rule using any of systolic blood pressure >150 mm Hg, diastolic blood pressure >90 mm Hg, blood

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2016 BMJ open

69. The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward. (PubMed)

The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward. Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the McIsaac clinical decision rule can help physicians to diagnose and manage (...) streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the McIsaac rule in a clinical setting in Malaysia.This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the McIsaac rule and Group B comprised patients after the implementation.Unnecessary throat swab cultures were reduced by 40% (P

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2016 Pediatric Research

70. Oostenbrink Clinical Decision Rule for Meningitis

Oostenbrink Clinical Decision Rule for Meningitis Oostenbrink Clinical Decision Rule for Meningitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Oostenbrink Clinical Decision Rule for Meningitis Oostenbrink Clinical Decision Rule for Meningitis Aka: Oostenbrink Clinical Decision Rule for Meningitis II. Indications evaluation in children Ages: 1 month to 15 years old III. Criteria Duration of main symptoms: 1 pt/day (up to 10) : 2 pt Physical exam : 6.5 : 8.0 pt : 7.5 pt : 4.0 pt (CRP) CRP <5: 0 pt CRP <10: 0.5 pt CRP <15: 1.0 pt CRP <20: 1.5 pt CRP >20: 2.0 pt IV. Interpretation Score >8.5 points indicates need for V. References

2018 FP Notebook

71. Neutropenic Fever Clinical Decision Rule

Neutropenic Fever Clinical Decision Rule Neutropenic Fever Clinical Decision Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Neutropenic Fever Clinical Decision Rule Neutropenic Fever Clinical Decision Rule Aka: Neutropenic Fever Clinical Decision Rule , Multinational Association for Supportive Care in Cancer Risk Index , MASCC Risk Index II. Indications Assess risk in III. Contraindications Children under age 16 years (have different rules for risk stratification) IV. Criteria symptom severity (choose one) No symptoms or Mild symptoms: 5 points Moderate symptoms: 3 points not present: 5 points not present: 4 points Solid tumor

2018 FP Notebook

72. Nigrovic Clinical Decision Rule

Nigrovic Clinical Decision Rule Nigrovic Clinical Decision Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Nigrovic Clinical (...) Decision Rule Nigrovic Clinical Decision Rule Aka: Nigrovic Clinical Decision Rule , CSF Interpretation for Predicting Bacterial Meningitis , Bacterial Meningitis Score II. Indications evaluation in children over age 2 months and under age 19 years old III. Contraindications: Exclusion Criteria Neurosurgical history Immunosuppression CSF >0.1 x10^6/ul (>1000/ul) Antibiotic use in last 48 hours IV. Criteria (1 point for each) CSF for organisms >79 mg/dl related to current episode Peripheral > 10,000

2018 FP Notebook

73. Clinical Decision Rule

Clinical Decision Rule Clinical Decision Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Clinical Decision Rule Clinical Decision (...) Rule Aka: Clinical Decision Rule , Decision Support Techniques , Clinical Prediction Rule , Decision Aids II. Indications Risk stratification for the evaluation and management of presentations with risk of poor outcome Limit testing that would otherwise risk adverse effects (e.g. radiation exposure) Standardize the approach to common conditions (esp. for those with less experience) Checklist documentation to prevent errors III. Precautions: Pitfalls Clinical Decision Rules may be misapplied Use

2018 FP Notebook

74. Validation of the PECARN Clinical Decision Rule for Children With Minor Head Trauma

Validation of the PECARN Clinical Decision Rule for Children With Minor Head Trauma Validation of the PECARN Clinical Decision Rule for Children With Minor Head Trauma - 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. Validation of the PECARN Clinical Decision Rule for Children With Minor Head Trauma 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. Read our for details. ClinicalTrials.gov Identifier: NCT02752711 Recruitment Status : Completed First Posted : April 27, 2016 Last Update Posted : May 2, 2016 Sponsor: Nantes University Hospital Information

2016 Clinical Trials

75. Cost-Effectiveness of Integrating a Clinical Decision Rule and Staged Imaging Protocol for Diagnosis of Appendicitis. (PubMed)

Cost-Effectiveness of Integrating a Clinical Decision Rule and Staged Imaging Protocol for Diagnosis of Appendicitis. To evaluate the cost-effectiveness of a diagnostic protocol for appendicitis in children, the use of a validated clinical decision rule (CDR) and a staged imaging protocol, compared with usual care.We estimated the cost-effectiveness of the three competing strategies using parameters from existing literature as well as a Markov model developed to simulate the effects of exposure

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2016 Value in Health

76. Termination of Resuscitation in the Prehospital Setting: A Comparison of Decisions in Clinical Practice vs. Recommendations of a Termination Rule. (PubMed)

Termination of Resuscitation in the Prehospital Setting: A Comparison of Decisions in Clinical Practice vs. Recommendations of a Termination Rule. Of the proposed algorithms that provide guidance for in-field termination of resuscitation (TOR) decisions, the guidelines for cardiopulmonary resuscitation (CPR) refer to the basic and advanced life support (ALS)-TOR rules. To assess the potential consequences of implementation of the ALS-TOR rule, we performed a case-by-case evaluation of our (...) in-field termination decisions and assessed the corresponding recommendations of the ALS-TOR rule.Cohort of non-traumatic out-of-hospital cardiac arrest (OHCA)-patients who were resuscitated by the ALS-practising emergency medical service (EMS) in the Nijmegen area (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC).Of the 598 cases reviewed, resuscitative

2016 Resuscitation

77. Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation. (PubMed)

Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation. Unprovoked first venous thromboembolism (VTE) is defined as VTE in the absence of a temporary provoking factor such as surgery, immobility and other temporary factors. Recurrent VTE in unprovoked patients is highly prevalent, but easily preventable with oral anticoagulant (OAC (...) ) from several studies. The final aim is to assess the economic cost-effectiveness of the proposed prognostic model if it is used as a decision rule for resuming OAC therapy, compared with current standard treatment strategies.Standard systematic review methodology was used to identify relevant prognostic model development, validation and cost-effectiveness studies. Bibliographic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched using terms relating to the clinical area

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2016 Health technology assessment (Winchester, England)

78. Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. (PubMed)

Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. To date, the Pediatric Emergency Care Applied Research Network (PECARN) rule for identifying children who are at very low risk of clinically-important traumatic brain injuries after minor head trauma has not been validated prospectively in an independent population. Our goal was to evaluate the diagnostic performance of the PECARN clinical decision rule in a French (...) (CT) scan was performed on 76 patients (5.1 %). Of the 1499 included patients, 9 children (0.6 %) had a clinically-important traumatic brain injury, and none were classified as very low risk by the PECARN rule. In our study, the sensitivity of this clinical decision rule was 100 % (95 % CI 66.4 to 100 %), the specificity was 69.9 % (95 % CI 67.5 to 72.2 %) and the negative predictive value was 100 % (95 % CI 99.7 to 100 %).Our study confirmed the good predictive performances of the PECARN clinical

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2016 Scandinavian journal of trauma, resuscitation and emergency medicine

79. Exploring the acceptability of a clinical decision rule to identify paediatric burns due to child abuse or neglect. (PubMed)

Exploring the acceptability of a clinical decision rule to identify paediatric burns due to child abuse or neglect. An evidence based clinical decision rule (CDR) was developed from a systematic review and epidemiological study to identify burns due to child maltreatment (abuse or neglect). Prior to an implementation evaluation, we aim to explore clinicians' views of the CDR, the likelihood that it would influence their management and factors regarding its acceptability.A semistructured (...) forma useful (45/55, 81.8%). Only five clinicians said that they would not take the action recommended by the CDR (5/54, 9.3%). Lower grade doctors were more likely to follow the CDR recommendations (p=0.04) than any other grade, while senior doctors would consider it within their decision making. Factors influencing uptake include: brief training, background to CDR development and details of appropriate actions.It is apparent that clinicians are willing to use a CDR to assist in identifying burns

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2016 Emergency Medicine Journal

80. Implementation of Clinical Decision Support Rules to Reduce Repeat Measurement of Serum Ionized Calcium, Serum Magnesium, and N-Terminal Pro-Brain Natriuretic Peptide in Intensive Care Unit Inpatients. (PubMed)

Implementation of Clinical Decision Support Rules to Reduce Repeat Measurement of Serum Ionized Calcium, Serum Magnesium, and N-Terminal Pro-Brain Natriuretic Peptide in Intensive Care Unit Inpatients. We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center.A repeat order (...) dramatically decreased repeat testing of iCa, Mg, and NT-proBNP without adversely impacting clinical outcomes in the ICU. Expansion of the rules from the ICU units to include the entire hospitalized patient population and expansion to additional analytes is expected to lead to further reductions in testing.© 2016 American Association for Clinical Chemistry.

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2016 Clinical Chemistry

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