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Clinical Decision Rule

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12621. Derivation of a clinical decision rule to exclude thoracic aortic imaging in patients with blunt chest trauma after motor vehicle collisions. Full Text available with Trip Pro

Derivation of a clinical decision rule to exclude thoracic aortic imaging in patients with blunt chest trauma after motor vehicle collisions. Thoracic aortic injury (TAI) is associated with high mortality. It is not practical to evaluate all patients with blunt chest trauma with dedicated aortic imaging. The purpose of this study was to define a group of patients with blunt chest trauma after motor vehicle collision (MVC) that do not require aortic imaging based on information available (...) in the emergency department.This was a secondary analysis of a prospectively-collected database. Consecutive patients with blunt chest trauma after MVC were included. Characteristics of mechanism, examination, and chest radiographic findings were collected for each patient. All patients underwent chest computed tomography (CT), aortography, or both for TAI evaluation. Binary recursive partitioning was used to derive and validate a clinical decision rule to predict exclusion of TAI.During the study period

2006 Journal of Trauma

12622. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Full Text available with Trip Pro

A clinical decision rule for cranial computed tomography in minor pediatric head trauma. To develop a sensitive clinical decision rule with a high negative predictive value for the use of cranial computed tomography (CT) in minor pediatric head trauma, to identify clinical features predictive of neurosurgical intervention, and to assess clinicians' predictive abilities to determine the presence or absence of intracranial injury based on history and physical examination alone.Prospective (...) defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%).We developed a sensitive clinical decision rule with a high NPV for detection

2008 Archives of Pediatrics & Adolescent Medicine

12623. International survey of emergency physicians' priorities for clinical decision rules. (Abstract)

International survey of emergency physicians' priorities for clinical decision rules. One of the first stages in the development of new clinical decision rules (CDRs) is determination of need. This study examined the clinical priorities of emergency physicians (EPs) working in Australasia, Canada, the United Kingdom, and the United States for the development of future CDRs.The authors administered an e-mail and postal survey to members of the national emergency medicine (EM) associations (...) in Australasia, Canada, the United Kingdom, and the United States. Results were analyzed via frequency distributions.The total response rate was 54.8% (1,150/2,100). The respondents were primarily male (74%), with a mean age of 42.5 years (SD +/- 8), and a mean of 12 years of experience (SD +/- 7). The top 10 clinical priorities (% selected) were: 1) investigation of febrile child < 36 months (62%); 2) identification of central or serious vertigo (42%); 3) lumbar puncture or admission of febrile child < 3

2008 Academic Emergency Medicine

12624. Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Full Text available with Trip Pro

Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Descriptive study.To compare clinical decision rules in low back pain guidelines for identification of neurologic involvement.Low back pain guidelines have been developed in a number of countries. Guideline recommendations for assessment of patients with low back pain in primary care include clinical decision rules for identification of neurologic involvement. Broad variation (...) in recommended clinical assessments has previously been identified. More specific investigation of these clinical assessments seems warranted given that guidelines have an important role in facilitating accurate and timely identification of neurologic involvement in patients with low back pain presenting in primary care.Guidelines were included that met the following criteria: the guideline included clinical decision rules for low back pain assessments; recommendations were for clinical management of low

2008 Spine

12625. Implementation of clinical decision rules in the emergency department. (Abstract)

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

2007 Academic Emergency Medicine

12626. Clinical decision rules to distinguish between bacterial and aseptic meningitis. Full Text available with Trip Pro

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

2006 Archives of Disease in Childhood

12627. Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule. Full Text available with Trip Pro

Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule. To test the reproducibility of a highly sensitive clinical decision rule proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combines clinical (family history of uropathology, male gender, young age), biological (raised C reactive protein), and radiological (urinary tract dilation on renal (...) for all-grade VUR, and 93% sensitivity and 13% specificity for grade > or =3 VUR. Some methodological weaknesses explain this lack of reproducibility.The reproducibility of the previously proposed decision rule was poor and its potential contribution to clinical management of children with febrile urinary tract infection seems to be modest.

2006 Archives of Disease in Childhood

12628. Evaluation of the WHO clinical decision rule for streptococcal pharyngitis. Full Text available with Trip Pro

Evaluation of the WHO clinical decision rule for streptococcal pharyngitis. To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS) pharyngitis in three countries.A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis.The proportion of children

2005 Archives of Disease in Childhood

12629. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Full Text available with Trip Pro

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

2006 Archives of Disease in Childhood

12630. Identifying subfertile ovulatory women for timely tubal patency testing: a clinical decision rule based on medical history. Full Text available with Trip Pro

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

2007 Human Reproduction

12631. A clinical decision rule to identify children at low risk for appendicitis. (Abstract)

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

12632. Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule. (Abstract)

Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule. Recently, investigators described a clinical decision rule for termination of resuscitation (TOR) designed to help determine whether to terminate emergency medical services (EMS) resuscitative efforts for out-of-hospital cardiac arrests (OOHCA). The authors sought to evaluate the hypothesis that TOR would predict no survival for patients in an independent cohort of patients with OOHCA.This (...) in an independent, statewide OOHCA database. The results are consistent with the findings of the TOR investigation and suggest that this algorithm is a promising tool for TOR decision-making in the field.

2008 Academic Emergency Medicine

12633. Clinical decision rules for secondary trauma triage: predictors of emergency operative management. (Abstract)

Clinical decision rules for secondary trauma triage: predictors of emergency operative management. Most injured patients taken by ambulance to hospital emergency departments do not require emergency surgery, yet most US trauma centers require a surgeon to be present on their arrival. If a clinical decision rule could be developed to accurately identify which injured patients require emergency operative intervention, then such "secondary triage" criteria could permit a trauma center to more (...) efficiently use their surgeons' time.We analyzed 7.5 years of data (8,289 consecutive trauma activations) in our prospectively maintained Level I trauma center registry. We used classification and regression tree analyses to generate clinical decision rules using standard out-of-hospital variables to identify emergency operative intervention (within 1 hour) by a general surgeon (for adults) or a pediatric surgeon (if < or =14 years).Emergency operative intervention occurred in 3.0% of adults and 0.35

2006 Annals of Emergency Medicine

12634. Computer-assisted categorizing of head computed tomography reports for clinical decision rule research. (Abstract)

Computer-assisted categorizing of head computed tomography reports for clinical decision rule research. To develop software that categorizes electronic head computed tomography (CT) reports into groups useful for clinical decision rule research.Data were obtained from the Second National Emergency X-Radiography Utilization Study, a cohort of head injury patients having received head CT. CT reports were reviewed manually for presence or absence of clinically important subdural or epidural (...) with manual categorization of all reports, including indeterminate ones (weighted kappa 0.62; 95% confidence interval [CI] 0.58 to 0.65). Sensitivity, specificity, and efficiency of the computerized system for identifying manual positives and negatives were 96% (95% CI 91% to 98%), 98% (95% CI 98% to 99%), and 79% (95% CI 77% to 80%), respectively.Categorizing head CT reports by computer for clinical decision rule research is feasible.

2006 Annals of Emergency Medicine

12635. A clinical decision rule to identify which chest pain patients can safely be removed from cardiac monitoring in the emergency department. (Abstract)

A clinical decision rule to identify which chest pain patients can safely be removed from cardiac monitoring in the emergency department. We determine the rate of serious arrhythmias in a cohort of monitored emergency department (ED) chest pain patients and derive a clinical decision rule that can identify which patients can safely be taken off continuous cardiac monitoring at initial physician assessment.A secondary analysis of a prospectively collected cohort was completed in a university (...) are uncommon in monitored ED chest pain patients. A simple clinical decision rule could be used to safely identify low-risk patients who can be removed from continuous monitoring if its performance is prospectively validated in an independent patient population.

2007 Annals of Emergency Medicine

12636. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: exploring decision rules for clinical utility. Full Text available with Trip Pro

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.

2005 Annals of the Rheumatic Diseases

12637. Prospective use of a clinical decision rule to identify pulmonary embolism as likely cause of outpatient cardiac arrest. (Abstract)

Prospective use of a clinical decision rule to identify pulmonary embolism as likely cause of outpatient cardiac arrest. A clinical decision rule (CDR) derived retrospectively found that 57% of outpatients aged 65 years or less, with witnessed arrest+PEA had pulmonary embolism (PE) as cause of cardiac arrest. These retrospectively studied patients also had significant frequency of pre-arrest respiratory distress, altered mental status, and shock.(1) To test prospectively the feasibility (...) and diagnostic accuracy of this CDR. (2) To test if the pre-arrest clinical triad of respiratory distress, altered mental status and shock predicts the presence of PE. All EMS personnel (N=204) in an urban EMS system and Emergency Department physicians (N=143) at 7 hospitals were included in the CDR and data collection.age 18-70, non-trauma, witnessed arrest, PEA as the first and primary rhythm. Exclusion: defibrillation before or more often than once after PEA. Criterion standards: autopsy or predefined

2005 Resuscitation

12638. Derivation of a clinical decision rule to guide the interhospital transfer of patients with blunt traumatic brain injury. Full Text available with Trip Pro

Derivation of a clinical decision rule to guide the interhospital transfer of patients with blunt traumatic brain injury. To derive a clinical decision rule for people with traumatic brain injury (TBI) that enables early identification of patients requiring specialised trauma care.We collected data from 1999 through 2003 on a retrospective cohort of consecutive people aged 18-65 years with a serious head injury (AIS > or =3), transported directly from the scene of injury, and evaluated (...) in the ED. Information on 22 demographical, physiological, radiographic, and lab variables was collected. Resource based "high therapeutic intensity" measures occurring within 72 hours of ED arrival (the outcome measure) were identified a priori and included: neurosurgical intervention, exploratory laparotomy, intensive care interventions, or death. We used classification and regression tree analysis to derive and cross validate the decision rule.504 consecutive trauma patients were identified as having

2005 Emergency Medicine Journal

12639. Evaluation of a clinical decision rule for young adult patients with chest pain. (Abstract)

Evaluation of a clinical decision rule for young adult patients with chest pain. The authors sought to validate a clinical decision rule that young adult (younger than 40 years) chest pain patients without known cardiac disease who had either no cardiac risk factors and/or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day adverse cardiovascular (CV) events.A prospective cohort study of patients 24-39 years old who received an ECG for chest pain (...) %). Ninety-eight percent were available for 30-day follow-up. The overall risks of ACS and 30-day adverse CV events were 5.4% and 2.2%, respectively, in our entire cohort. For patients with no cardiac history and no cardiac risk factors, the risk of ACS and 30-day adverse CV events was 1.8%. The risk in patients with no cardiac history and a normal ECG was 1.3%. Patients with no cardiac history, no cardiac risk factors, and a normal ECG had a risk of 1.0%. A modified clinical decision rule found

2005 Academic Emergency Medicine

12640. Deferral of the rectal examination in blunt trauma patients: a clinical decision rule. (Abstract)

Deferral of the rectal examination in blunt trauma patients: a clinical decision rule. To develop a clinical decision rule that would allow for the safe deferral of the digital rectal examination (DRE) in blunt trauma patients.The authors reviewed the medical records of all adult blunt trauma patients meeting trauma team activation criteria over a 14-month period. The results of the DRE and six predictor variables-abnormal neurologic examination, abdominal tenderness, pelvic stability, blood

2004 Academic Emergency Medicine

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