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Clinical Decision Rule

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12421. The San Francisco Syncope Rule vs physician judgment and decision making. (PubMed)

The San Francisco Syncope Rule vs physician judgment and decision making. To compare a clinical decision rule (San Francisco Syncope Rule [SFSR]) and physician decision making when predicting serious outcomes in patients with syncope.In a prospective cohort study, physicians evaluated patients presenting with syncope and predicted the chance (0%-100%) of the patient developing a predefined serious outcome. They were then observed to determine their decision to admit the patient. All patients (...) were followed up to determine whether they had a serious outcome within 7 days of their emergency department visit. Analyses included sensitivity and specificity to predict serious outcomes for low-risk patients and comparison of areas under the receiver operating characteristic curve for the decision rule, physician judgment, and admission decisions.During the study period, there were 684 visits for syncope with 79 visits resulting in serious outcomes. The area under the receiver operating

2005 American Journal of Emergency Medicine

12422. Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. (PubMed)

Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. To prospectively validate a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes (MVCs).The authors selected 20 Los Angeles County Fire Department fire stations, based on pediatric MVC call volume and geographic diversity, and 21 associated hospitals for participation in the study (...) or death in the first 24 hours, or pediatric intensive care unit stay longer than 48 hours), as assessed by retrospective chart review. Accuracy measures and binominal confidence intervals (CIs) were calculated for the decision rule validation.One hundred seventy-five children were prospectively enrolled in the study; 36 children were excluded due to lack of hospital participation or missing hospital charts. There were four children with ISS > or = 16 (3%) and six children requiring specialized trauma

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2005 Academic Emergency Medicine

12423. Emergency medicine practitioner knowledge and use of decision rules for the evaluation of patients with suspected pulmonary embolism: variations by practice setting and training level. (PubMed)

Emergency medicine practitioner knowledge and use of decision rules for the evaluation of patients with suspected pulmonary embolism: variations by practice setting and training level. Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments.To characterize clinicians' knowledge of and attitudes toward two commonly used CDRs (...) for PE.By using a modified Delphi approach, the authors developed a two-page paper survey including 15 multiple-choice questions. The questions were designed to determine the respondents' familiarity, frequency of use, and comprehension of the Canadian and Charlotte rules. The survey also queried the frequency of use of unstructured (gestalt) pretest probability assessment and reasons why physicians choose not to use decision rules. The surveys were sent to physicians, physician assistants, and medical

2007 Academic Emergency Medicine

12424. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. (PubMed)

A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Computed tomography (CT) is frequently used in evaluating children with blunt head trauma. Routine use of CT, however, has disadvantages. Therefore, we sought to derive a decision rule for identifying children at low risk for traumatic brain injuries.We enrolled children with blunt head trauma at a pediatric trauma center in an observational cohort study between July 1998 and September 2001. We (...) evaluated clinical predictors of traumatic brain injury on CT scan and traumatic brain injury requiring acute intervention, defined by a neurosurgical procedure, antiepileptic medications for more than 1 week, persistent neurologic deficits, or hospitalization for at least 2 nights. We performed recursive partitioning to create clinical decision rules.Two thousand forty-three children were enrolled, 1,271 (62%) underwent CT, 98 (7.7%; 95% confidence interval [CI] 6.3% to 9.3%) had traumatic brain

2003 Annals of Emergency Medicine

12425. Judge over-rules earlier decision on Charlotte Wyatt (PubMed)

Judge over-rules earlier decision on Charlotte Wyatt 16254290 2005 11 14 2012 03 06 1756-1833 331 7523 2005 Oct 29 BMJ (Clinical research ed.) BMJ Judge over-rules earlier decision on Charlotte Wyatt. 985 Dyer Clare C eng News England BMJ 8900488 0959-8138 AIM E IM Child Disabled Children England Female Humans Judicial Role Resuscitation Orders legislation & jurisprudence 124919 Death and Euthanasia Legal Approach KIE Bib: allowing to die/infants; allowing to die/legal aspects 2005 10 29 9 0

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2005 BMJ : British Medical Journal

12426. GMC challenges court ruling on end of life decisions (PubMed)

GMC challenges court ruling on end of life decisions 15905235 2005 06 09 2016 11 14 1756-1833 330 7501 2005 May 21 BMJ (Clinical research ed.) BMJ GMC challenges court ruling on end of life decisions. 1165 Dyer Clare C eng News England BMJ 8900488 0959-8138 2005 5 21 9 0 2005 5 21 9 1 2005 5 21 9 0 ppublish 15905235 330/7501/1165 10.1136/bmj.330.7501.1165 PMC558002

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2005 BMJ : British Medical Journal

12427. High Court judge over-rules GMC decision not to proceed against GP (PubMed)

High Court judge over-rules GMC decision not to proceed against GP 17110714 2006 11 27 2012 03 06 1756-1833 333 7577 2006 Nov 18 BMJ (Clinical research ed.) BMJ High Court judge over-rules GMC decision not to proceed against GP. 1037 Dyer Clare C eng News England BMJ 8900488 0959-8138 AIM IM England Family Practice legislation & jurisprudence Malpractice legislation & jurisprudence 2006 11 18 9 0 2006 12 9 9 0 2006 11 18 9 0 ppublish 17110714 333/7577/1037-a 10.1136/bmj.39031.650637.DB

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2006 BMJ : British Medical Journal

12428. Ottawa ankle rules for the injured ankle : Useful clinical rules save on radiographs and need to be used widely (PubMed)

Ottawa ankle rules for the injured ankle : Useful clinical rules save on radiographs and need to be used widely 12595349 2003 03 27 2018 11 13 1756-1833 326 7386 2003 Feb 22 BMJ (Clinical research ed.) BMJ Ottawa ankle rules for the injured ankle. 405-6 Heyworth John J eng Editorial Comment England BMJ 8900488 0959-8138 AIM IM BMJ. 2003 May 24;326(7399):1147; author reply 1147 12764008 BMJ. 2003 Feb 22;326(7386):417 12595378 Ankle Injuries diagnostic imaging Decision Support Techniques

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2003 BMJ : British Medical Journal

12429. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. (PubMed)

A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. A prospective, cohort study of patients with nonradicular low back pain referred to physical therapy.Develop a clinical prediction rule for identifying patients with low back pain who improve with spinal manipulation.Development of clinical prediction rules for classifying patients with low back pain who are likely to respond to a particular intervention (...) , such as manipulation, would improve clinical decision-making and research.Patients with nonradicular low back pain underwent a standardized examination and then underwent a standardized spinal manipulation treatment program. Success with treatment was determined using percent change in disability scores over three sessions and served as the reference standard for determining the accuracy of examination variables. Examination variables were first analyzed for univariate accuracy in predicting success

2002 Spine

12430. Perioperative mortality of elective abdominal aortic aneurysm surgery. A clinical prediction rule based on literature and individual patient data. (PubMed)

by the positive correlation between the risk factors. In the clinical prediction rule, cardiac, renal, and pulmonary comorbidity are the most important risk factors, while age per se has a moderate effect on mortality.A readily applicable clinical prediction rule can be based on the combination of literature data and individual patient data. The risk estimates may be useful for clinical decision making in individual patients. (...) Perioperative mortality of elective abdominal aortic aneurysm surgery. A clinical prediction rule based on literature and individual patient data. Abdominal aortic aneurysm surgery is a major vascular procedure with a considerable risk of (mainly cardiac) mortality.To estimate elective perioperative mortality, we developed a clinical prediction rule based on several well-established risk factors: age, gender, a history of myocardial infarction, congestive heart failure, ischemia

1995 Archives of internal medicine

12431. A clinical rules taxonomy for the implementation of a computerized physician order entry (CPOE) system. (PubMed)

A clinical rules taxonomy for the implementation of a computerized physician order entry (CPOE) system. Many of the benefits of computerized physician order entry (CPOE) stem from its ability to support medical decision-making and error-reduction during patient care. This automated "intelligence" is typically represented by a network of rules. We describe a taxonomic representation of clinical decision-support rules in the context of developing and implementing a de novo CPOE and decision (...) -support system. In our experience, this clinical rules taxonomy facilitated our implementation goals in the areas of physician acceptance and approval, rules construction and maintenance, and technical development and testing. This rules taxonomy may eventually be used to establish standards by which CPOE-based decision-support is measured.

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2002 Proceedings of the AMIA Symposium

12432. Canadian CT Head Rule: CT head rules for trauma

to advise a return visit to the ED. Absence of all of these features indicated a lack of clinically important brain injury Patients who received CT head were compared to those who did not Various statistical methods used to determine risk factors for need for neurological intervention and clinically important brain injury Outcomes Performance of high-risk decision rule, consisting of 5 criteria. High risk by decision rule, requiring neurological intervention Sensitivity 100% (95% CI 0.92-1.00 (...) ) Specificity 68.7% (95% CI 0.67-0.70) Performance of all factors, consisting of 7 criteria. Moderate risk by decision rule, with clinically important injury Sensitivity 98.4% (95% CI 0.96-0.99) Specificity 49.6% (95% CI 0.48-0.51) Criticisms 363 patients who did not meet CT criteria were not included in the final statistical analysis, because they were lost to follow-up. 1358 patients presented to the study center EDs for minor head trauma, however were not enrolled in the study. The 14-day follow-up

2001 Wiki Journal Club

12433. Translating clinical research into clinical practice: impact of using prediction rules to make decisions. (PubMed)

Translating clinical research into clinical practice: impact of using prediction rules to make decisions. Clinical prediction rules, sometimes called clinical decision rules, have proliferated in recent years. However, very few have undergone formal impact analysis, the standard of evidence to assess their impact on patient care. Without impact analysis, clinicians cannot know whether using a prediction rule will be beneficial or harmful. This paper reviews standards of evidence for developing (...) and evaluating prediction rules; important differences between prediction rules and decision rules; how to assess the potential clinical impact of a prediction rule before translating it into a decision rule; methodologic issues critical to successful impact analysis, including defining outcome measures and estimating sample size; the importance of close collaboration between clinical investigators and practicing clinicians before, during, and after impact analysis; and the need to measure both efficacy

2006 Annals of Internal Medicine

12434. Ottawa Knee Rule: a comparison of physician and triage-nurse utilization of a decision rule for knee injury radiography. (PubMed)

Ottawa Knee Rule: a comparison of physician and triage-nurse utilization of a decision rule for knee injury radiography. The Ottawa Knee Rule (OKR) is a clinical decision rule for the ordering of knee radiographs by physicians in patients with blunt knee injuries. However, in many Emergency Departments, radiographs are also ordered by nurses during triage. This study was designed to compare application of the OKR by triage nurses and physicians. A consecutive sample of all patients presenting

2003 Journal of Emergency Medicine

12435. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: exploring decision rules for clinical utility. (PubMed)

EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: exploring decision rules for clinical utility. Synovial inflammation (as defined by hypertrophy and effusion) is common in osteoarthritis (OA) and may be important in both pain and structural progression.To determine if decision rules can be devised from clinical findings and ultrasonography (US) to allow recognition of synovial inflammation in patients with painful knee OA.A EULAR-ESCISIT cross sectional (...) ).Although it is possible to determine clinical and radiological predictors of OA inflammation in populations, CART analysis could not be used to devise useful clinical decision rules for an individual subject. Thus sensitive imaging techniques such as US remain the most useful tool for demonstrating synovial inflammation of the knee at the individual level.

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2005 Annals of the Rheumatic Diseases

12436. Implementation of clinical decision rules in the emergency department. (PubMed)

Implementation of clinical decision rules in the emergency department. Clinical decision rules (CDRs) are tools designed to help clinicians make bedside diagnostic and therapeutic decisions. The development of a CDR involves three stages: derivation, validation, and implementation. Several criteria need to be considered when designing and evaluating the results of an implementation trial. In this article, the authors review the results of implementation studies evaluating the effect of four (...) CDRs: the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule, and the Canadian CT Head Rule. Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries. However, a recent trial failed to demonstrate an impact on computed tomography imaging rates. Well-developed and validated CDRs can be successfully implemented into practice, efficiently standardizing ED

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2007 Academic Emergency Medicine

12437. Identifying subfertile ovulatory women for timely tubal patency testing: a clinical decision rule based on medical history. (PubMed)

Identifying subfertile ovulatory women for timely tubal patency testing: a clinical decision rule based on medical history. The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred.Data on 3716 women who underwent tubal patency testing as a part of their routine fertility workup were used to relate (...) ) of 0.65 (95% CI: 0.63-0.68) for any tubal pathology and 0.68 (95% CI: 0.65-0.71) for bilateral tubal pathology, respectively. However, the models could make an almost perfect distinction between women with a high and a low probability of tubal pathology. A decision rule in the form of a simple diagnostic score chart was developed for application of the models in clinical practice.In conclusion, the present study provides two easy to use decision rules that can accurately express a woman's probability

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2007 Human Reproduction

12438. A clinical decision rule to identify children at low risk for appendicitis. (PubMed)

A clinical decision rule to identify children at low risk for appendicitis. Computed tomography (CT) has gained widespread acceptance in the evaluation of children with suspected appendicitis. Concern has been raised regarding the long-term effects of ionizing radiation. Other means of diagnosing appendicitis, such as clinical scores, are lacking in children. We sought to develop a clinical decision rule to predict which children with acute abdominal pain do not have appendicitis.Prospective (...) cohort study was conducted of children and adolescents who aged 3 to 18 years, had signs and symptoms suspicious for appendicitis, and presented to the emergency department between April 2003 and July 2004. Standardized data-collection forms were completed on eligible patients. Two low-risk clinical decision rules were created and validated using logistic regression and recursive partitioning. The sensitivity, negative predictive value (NPV), and negative likelihood ratio of each clinical rule were

2005 Pediatrics

12439. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. (PubMed)

Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. A quarter of all patients presenting to emergency departments are children. Although there are several large, well-conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children.To conduct a prospective multicentre diagnostic cohort study (...) a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% confidence interval (CI) 96% to 100%) and a specificity of 87% (95% CI 86% to 87%) for the prediction of clinically significant head injury, and requires a computed tomography scan rate of 14%.A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury. This rule has the potential to improve and standardise the care

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2006 Archives of Disease in Childhood

12440. Clinical decision rules to distinguish between bacterial and aseptic meningitis. (PubMed)

Clinical decision rules to distinguish between bacterial and aseptic meningitis. Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations.To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules.All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been (...) included in a retrospective cohort study. Sensitivity and specificity were calculated by applying each rule to the patients. The best rule was a priori defined as the one yielding 100% sensitivity for bacterial meningitis, the highest specificity, and the greatest simplicity for a bedside application.Among the 166 patients included, 20 had bacterial meningitis and 146 had aseptic meningitis. Although three rules achieved 100% sensitivity (95% CI 84-100), one had a significantly lower specificity (13

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2006 Archives of Disease in Childhood

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