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Clinical Decision Rule

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101. Can Emergency Physician Gestalt "Rule In" or "Rule Out" Acute Coronary Syndrome: Validation in a Multicenter Prospective Diagnostic Cohort Study. (Abstract)

Can Emergency Physician Gestalt "Rule In" or "Rule Out" Acute Coronary Syndrome: Validation in a Multicenter Prospective Diagnostic Cohort Study. Chest pain is a common problem presenting to the emergency department (ED). Many decision aids and accelerated diagnostic protocols have been developed to help clinicians differentiate those needing admission from those who can be safely discharged. Some early evidence has suggested that clinician judgment or gestalt alone could be sufficient.Our aim (...) cardiac troponin (cTn) concentration, 100.0% sensitivity and NPV could be achieved. However, this strategy only applied to 4.1% of patients. If patients with "probably not" ACS who had normal ECG and cTn were also ruled out (n = 418, 30.8%), sensitivity fell to 86.2% with 99.2% NPV. Using gestalt "definitely" ACS to rule in ACS gave a specificity of 98.5% and positive predictive value of 71.2%.Clinician gestalt is not sufficiently accurate or safe to either rule in or rule out ACS as a decision-making

2019 Academic Emergency Medicine

102. Can emergency physician gestalt "rule in" or "rule out" acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study. (Abstract)

Can emergency physician gestalt "rule in" or "rule out" acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study. We thank Dr de Souza and Dr Sinert for their comments regarding our study. Indeed we heartily concur that our study took an entirely pragmatic approach, allowing all doctors of sufficient seniority to make clinical decisions to participate. We also acknowledge that doctors were not blinded to initial cardiac troponin or electrocardiogram results (...) . As the study took place in real time involving real patients, we realized in advance that it would have been unethical to blind physicians to such important clinical information.© 2019 by the Society for Academic Emergency Medicine.

2019 Academic Emergency Medicine

103. Nexus Chest CT Decision Rule in Blunt Trauma

rules have poor and is useful only when negative Use clinical judgment to determine CT indications VI. References Lin and Rodriguez in Herbert (2016) EM:Rap 16(2): 10-11 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Nexus Chest CT Decision Rule in Blunt Trauma." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Radiology About (...) Nexus Chest CT Decision Rule in Blunt Trauma Nexus Chest CT Decision Rule in Blunt Trauma 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

2018 FP Notebook

104. The Cape Town Clinical Decision Rule for Streptococcal Pharyngitis in Children. Full Text available with Trip Pro

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

2016 Pediatric Infectious Dsease Journal

105. Exploring the acceptability of a clinical decision rule to identify paediatric burns due to child abuse or neglect. Full Text available with Trip Pro

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

2016 Emergency Medicine Journal

106. 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. Full Text available with Trip Pro

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.

2016 Clinical Chemistry

107. The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward. Full Text available with Trip Pro

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

2016 Pediatric Research

108. Cost-Effectiveness of Integrating a Clinical Decision Rule and Staged Imaging Protocol for Diagnosis of Appendicitis. Full Text available with Trip Pro

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

2016 Value in Health

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

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

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

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

111. Clinical decision rules for acute bacterial meningitis: current insights Full Text available with Trip Pro

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.

2016 Open access emergency medicine : OAEM

112. 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

113. Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. Full Text available with Trip Pro

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

2016 Scandinavian journal of trauma, resuscitation and emergency medicine

114. New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study. Full Text available with Trip Pro

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

2016 BMJ open

115. Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study. Full Text available with Trip Pro

Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study. To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children.Retrospective analysis of data from a two year

2013 BMJ

116. Development and Validation of a Clinical Prediction Rule for Bacteremia among Maintenance Hemodialysis Patients in Outpatient Settings. Full Text available with Trip Pro

Development and Validation of a Clinical Prediction Rule for Bacteremia among Maintenance Hemodialysis Patients in Outpatient Settings. To our knowledge, no reliable clinical prediction rule (CPR) for identifying bacteremia in hemodialysis (HD) patients has been established. The aim of this study was to develop a CPR for bacteremia in maintenance HD patients visiting the outpatient department.This multicenter cohort study involved consecutive maintenance HD patients who visited the outpatient (...) % and 51.4%, respectively.We established a simple CPR for bacteremia in maintenance HD patients using routinely obtained clinical information in an outpatient setting. This model may facilitate more appropriate clinical decision making.

2017 PLoS ONE

117. "Rule of Spence" and Dickman's Classification of Transverse Atlantal Ligament Injury Revisited: Discrepancy of Prediction on Atlantoaxial Stability Based on Clinical Outcome of Non-Operative Treatment for Atlas Fractures. (Abstract)

"Rule of Spence" and Dickman's Classification of Transverse Atlantal Ligament Injury Revisited: Discrepancy of Prediction on Atlantoaxial Stability Based on Clinical Outcome of Non-Operative Treatment for Atlas Fractures. Detailed clinical information of 13 adult patients with acute atlantal fractures underwent nonoperative treatment was retrospectively studied. "Rule of Spence" was found inaccurate in predicting either integrity of transverse atlantal ligament (TAL) or atlantoaxial stability (...) , whereas Dickman's classification of TAL injury was more superior to "rule of Spence" on both prediction.A retrospective study.To evaluate the prediction accuracy of "Rule of Spence" and Dickman's classification of the transverse atlantal ligament (TAL) injury on clinical outcomes (mainly focused on atlantoaxial stability) of atlas fractures treated nonoperatively.TAL is regarded as primary stabilizer of the atlantoaxial complex. Atlas fractures are categorized as unstable and stable according to TAL

2018 Spine

118. Development of Clinical Prediction Rules and Health Services Research in Patients With Heart Failure

Development of Clinical Prediction Rules and Health Services Research in Patients With Heart Failure Development of Clinical Prediction Rules and Health Services Research in Patients With Heart Failure - 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. Development of Clinical Prediction Rules and Health Services Research in Patients With Heart Failure (ESSIC) 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: NCT03512704 Recruitment Status : Completed First Posted : May 1, 2018 Last Update Posted : February 5

2018 Clinical Trials

119. Psychiatric Medications and Reproductive Safety: Scientific and Clinical Perspectives Pertaining to the US FDA Pregnancy and Lactation Labeling Rule. Full Text available with Trip Pro

Psychiatric Medications and Reproductive Safety: Scientific and Clinical Perspectives Pertaining to the US FDA Pregnancy and Lactation Labeling Rule. Pregnancy labeling of prescription medications in the US is in the midst of a major transformation. The FDA's previous system, which used letter ratings to convey drug safety, was simple but led to misunderstandings-both faulty assurances and undue concerns. The new system, established under the Pregnancy and Lactation Labeling Rule, aims for more (...) descriptive and up-to-date explanations of risk as well as context needed for informed decision-making based on available data. In April 2017, a conference titled "Pharmacovigilance, Reproductive Safety, and the Pregnancy and Lactation Labeling Rule" brought together clinicians and researchers, FDA officials, and representatives of the public and industry to discuss a host of questions relating to the new system. This Academic Highlights article summarizes their discussions, which included topics

2018 Journal of Clinical Psychiatry

120. Development of a clinical prediction rule to diagnose Pneumocystis jirovecii pneumonia in the World Health Organization’s algorithm for seriously ill HIV-infected patients Full Text available with Trip Pro

. The area under the receiver operating characteristic curve of the clinical prediction rule models was 0.761 (95% CI 0.683-0.840) for the respiratory rate model and 0.797 (95% CI 0.725-0.868) for the oxygen saturation model. Both models had zero probability for PJP for scores of zero, and positive likelihood ratios exceeded 10 for high scores.We developed simple clinical prediction rules for PJP, which, if externally validated, could assist decision-making in the WHO seriously ill algorithm. (...) Development of a clinical prediction rule to diagnose Pneumocystis jirovecii pneumonia in the World Health Organization’s algorithm for seriously ill HIV-infected patients The World Health Organization (WHO) algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients recommends that treatment for Pneumocystis jirovecii pneumonia (PJP) should be considered without giving clear guidance on selecting patients for empiric PJP therapy. PJP is a common cause

2018 Southern African journal of HIV medicine

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