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Clinical Decision Rule

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61. 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 (Full text)

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

2016 EvidenceUpdates PubMed abstract

62. A simple clinical decision rule to rule out appendicitis in patients with nondiagnostic ultrasound results (Abstract)

A simple clinical decision rule to rule out appendicitis in patients with nondiagnostic ultrasound results The objective was to identify a set of clinical features that can rule out appendicitis in patients with suspected acute appendicitis and nondiagnostic ultrasound (US) results, allowing safe discharge and next-day reevaluation without initial computed tomography (CT) or magnetic resonance imaging (MRI).Data on clinical and US evaluation, including a number of prespecified variables (...) potentially associated with acute appendicitis, were prospectively collected in two diagnostic accuracy studies of imaging. These studies included patients with suspected appendicitis seen in the emergency department (ED). For development and validation of the clinical decision rule (CDR), only patients with inconclusive or negative US results were included. There were 199 (of 422) patients in the development cohorts and 120 (of 211) patients in the validation cohort. Logistic regression analysis was used

2014 EvidenceUpdates

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

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

2014 EvidenceUpdates PubMed abstract

64. 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

65. 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

66. 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

67. 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

68. 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

69. Derivation and validation of a clinical decision rule to identify young children with skull fracture following isolated head trauma (Full text)

Derivation and validation of a clinical decision rule to identify young children with skull fracture following isolated head trauma There is no clear consensus regarding radiologic evaluation of head trauma in young children without traumatic brain injury. We conducted a study to develop and validate a clinical decision rule to identify skull fracture in young children with head trauma and no immediate need for head tomography.We performed a prospective cohort study in 3 tertiary care emergency (...) was at the physician's discretion. The clinical decision rule was derived using recursive partitioning.A total of 811 patients (49 with skull fracture) were recruited during the derivation phase. The 2 predictors identified through recursive partitioning were parietal or occipital swelling or hematoma and age less than 2 months. The rule had a sensitivity of 94% (95% confidence interval [CI] 83%-99%) and a specificity of 86% (95% CI 84%-89%) in the derivation phase. During the validation phase, 856 participants (44

2015 EvidenceUpdates PubMed abstract

70. Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study. (Full text)

Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study. The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort.We performed a prospective observational study of patients aged <18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs. In a planned secondary (...) analysis, we assessed the accuracy of the NEXUS II CDR (with 95% CI) to detect clinically important intracranial injury (ICI). We also assessed clinician accuracy without the rule.Of 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had ICI as defined by NEXUS II. 74 (19.6% of ICI) patients underwent neurosurgery.Sensitivity for ICI based on the NEXUS II CDR was 379/383 (99.0 (95% CI 97.3

2018 Emergency Medicine Journal PubMed abstract

71. Accuracy of Clinician Practice Compared With Three Head Injury Decision Rules in Children: A Prospective Cohort Study. (Full text)

Accuracy of Clinician Practice Compared With Three Head Injury Decision Rules in Children: A Prospective Cohort Study. Three clinical decision rules for head injuries in children (Pediatric Emergency Care Applied Research Network [PECARN], Canadian Assessment of Tomography for Childhood Head Injury [CATCH], and Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE]) have been shown to have high performance accuracy. The utility of any of these in a particular (...) clinician accuracy and a low CT rate, PECARN, CATCH, or CHALICE clinical decision rules have limited potential to increase the accuracy of detecting clinically important traumatic brain injury and may increase the CT rate.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

2018 Annals of Emergency Medicine PubMed abstract

72. Decision support system for triage management: A hybrid approach using rule-based reasoning and fuzzy logic. (Abstract)

engine and predict the triage levels.Fourteen RBR and 27 fuzzy rules were extracted and used in the rule-based engine. The performance of the system was evaluated using three methods with real triage data. The accuracy of the clinical decision support systems (CDSSs; in the test data) was 99.44%. The evaluation of the error rate revealed that, when using the traditional method, 13.4% of the patients were miss-triaged, which is statically significant. The completeness of the documentation also (...) Decision support system for triage management: A hybrid approach using rule-based reasoning and fuzzy logic. Fast and accurate patient triage for the response process is a critical first step in emergency situations. This process is often performed using a paper-based mode, which intensifies workload and difficulty, wastes time, and is at risk of human errors. This study aims to design and evaluate a decision support system (DSS) to determine the triage level.A combination of the Rule-Based

2018 International journal of medical informatics

73. JAK2-tree: a simple CBC-based decision rule to guide appropriate JAK2 V617F mutation testing. (Full text)

JAK2 V617F testing only when most appropriate.To assist with the screening of patients being considered for JAK2 V617F testing, we developed a clinical decision rule, "JAK2-tree", which can be easily applied to basic CBC parameters (haemoglobin, platelet and white blood cell counts).We tested JAK2-tree on two independent datasets, one an unselected population-based sample (the Copenhagen General Population Study) and the other an historical clinical laboratory referral set, with sensitivities (...) JAK2-tree: a simple CBC-based decision rule to guide appropriate JAK2 V617F mutation testing. The JAK2 V617F mutation is highly recurrent in many of the myeloproliferative neoplasms, a molecular variant that can be easily detected using sensitive and minimally invasive techniques. Given the ease of JAK2 V617F testing, this test may be improperly requested for the purposes of patient 'screening' and to optimise laboratory resource utilisation, it behooves clinicians and laboratorians to perform

2018 Journal of Clinical Pathology PubMed abstract

74. Data-based Decision Rules to Personalize Depression Follow-up (Full text)

Data-based Decision Rules to Personalize Depression Follow-up Depression is a common mental illness with complex and heterogeneous progression dynamics. Risk grouping of depression treatment population based on their longitudinal patterns has the potential to enable cost-effective monitoring policy design. This paper establishes a rule-based method to identify a set of risk predictive patterns from person-level longitudinal disease measurements by integrating the data transformation, rule (...) discovery and rule evaluation. We further extend the identified rules to create rule-based monitoring strategies to adaptively monitor individuals with different disease severities. We applied the rule-based method on an electronic health record (EHR) dataset of depression treatment population containing person-level longitudinal Patient Health Questionnaire (PHQ)-9 scores for assessing depression severity. 12 risk predictive rules are identified, and the rule-based prognostic model based on identified

2018 Scientific reports PubMed abstract

75. Symptoms in combination with risk factors and tests for ovarian cancer detection: a systematic review of prediction models and decision rules

Symptoms in combination with risk factors and tests for ovarian cancer detection: a systematic review of prediction models and decision rules 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. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content (...) , editorial) 2. Not an in vivo animal study 3. No metastases/ only primary tumor 4. 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

2020 PROSPERO

76. Effectiveness of strategies to increase the use of imaging decision rules for musculoskeletal injuries: a systematic review.

Effectiveness of strategies to increase the use of imaging decision rules for musculoskeletal injuries: 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. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any (...) . Not an in vivo animal study 3. No metastases/ only primary tumor 4. 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

2020 PROSPERO

77. Do Clinical Prediction Rules for Acute Pulmonary Embolism Have Sufficient Sensitivity to Identify Patients at Very Low Risk of Death?

- pulmonaryembolismall-cause mortality:abivariatemeta- analysis.Chest.2015;147:1043- 1062. 1. Whiting PF, Rutjes AWS, Westwood ME, et al; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529-536. 2. McGinn TG, Guyatt GH, Wyer PC, et al; Evidence-Based Medicine Working Group. Users’ guides to the medical literature: XXII: how to use articles about clinical decision rules. JAMA. 2000;284: 79-84. 3. Silverstein MD, Heit JA, Mohr DN, et al (...) Do Clinical Prediction Rules for Acute Pulmonary Embolism Have Sufficient Sensitivity to Identify Patients at Very Low Risk of Death? Systematic Review Snapshot TAKE-HOME MESSAGE Five pulmonary embolism clinical prediction rules to predict early all-cause mortality have sensitivities greater than 88%, but only 3 are supported by a high level of evidence. The simpli?ed Pulmonary Embolism Severity Index appears to have the greatest potential, given its relatively higher sensitivity and ease

2016 Annals of Emergency Medicine Systematic Review Snapshots

78. Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

articles. STUDY SELECTION Derivation, validation, or impact studies of a pediatric bacterial meningitis clinical prediction rule were included. Clinical prediction rules were de?ned as decision tools making use of 3 or more predictors and provided probability estimates of meningitis or guided treatment in children younger than 18 years. To be included, studies were required to measure cases of bacterial meningitis by cerebrospinal ?uid culture. Although both prospective and retrospective studies were (...) in children with suspected meningitis. However, the majority of the rules included in this review used chart review, an ultimately unreliable me- thodology for prediction rule development. In general, decision rules accurate and reliable enough to allow pro- viders and parents to forgo testing, empiric treatment, or admission when bacterial meningitis is a considerationshouldbedeveloped and validated prospectively. None of the currently derived and vali- dated clinical prediction rules for bacterial

2015 Annals of Emergency Medicine Systematic Review Snapshots

79. Designing, Conducting, and Reporting Clinical Decision Support Studies: Recommendations and Call to Action. (Abstract)

Designing, Conducting, and Reporting Clinical Decision Support Studies: Recommendations and Call to Action. By enabling more efficient and effective medical decision making, computer-based clinical decision support (CDS) could unlock widespread benefits from the significant investment in electronic health record (EHR) systems in the United States. Evidence from high-quality CDS studies is needed to enable and support this vision of CDS-facilitated care optimization, but limited guidance (...) is available in the literature for designing and reporting CDS studies. To address this research gap, this article provides recommendations for designing, conducting, and reporting CDS studies to: 1) ensure that EHR data to inform the CDS are available; 2) choose decision rules that are consistent with local care processes; 3) target the right users and workflows; 4) make the CDS easy to access and use; 5) minimize the burden placed on users; 6) incorporate CDS success factors identified in the literature

2020 Annals of Internal Medicine

80. Systematic review of the effects of care provided with and without diagnostic clinical prediction rules. (Full text)

Systematic review of the effects of care provided with and without diagnostic clinical prediction rules. Diagnostic clinical prediction rules (CPRs) are worthwhile if they improve patient outcomes or provide benefits such as reduced resource use, without harming patients. We conducted a systematic review to assess the effects of diagnostic CPRs on patient and process of care outcomes.We searched electronic databases and a trial registry and performed citation and reference checks (...) , for randomised trials comparing a diagnostic strategy with and without a CPR. Included studies were assessed for risk of bias and similar studies meta-analysed.Twenty-seven studies evaluating diagnostic CPRs for 14 conditions were included. A clinical management decision was the primary outcome in the majority of studies. Most studies were judged to be at high or uncertain risk of bias on ≥3 of 6 domains. Details of study interventions and implementation were infrequently reported.For suspected Group

2020 Diagnostic and prognostic research PubMed abstract

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