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Clinical Decision Rule

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161. Derivation of Candidate Clinical Decision Rules to Identify Infants at Risk for Central Apnea. (PubMed)

Derivation of Candidate Clinical Decision Rules to Identify Infants at Risk for Central Apnea. Central apnea complicates, and may be the presenting complaint in, bronchiolitis. Our objective was to prospectively derive candidate clinical decision rules (CDRs) to identify infants in the emergency department (ED) who are at risk for central apnea.We conducted a prospective observational study over 8 years. The primary outcome was central apnea subsequent to the initial ED visit. Infants were

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2015 Pediatrics

162. 441: SYSTEMATIC REVIEW OF CLINICAL DECISION RULES PREDICTING BACTEREMIA IN EMERGENCY DEPARTMENT PATIENTS. (PubMed)

441: SYSTEMATIC REVIEW OF CLINICAL DECISION RULES PREDICTING BACTEREMIA IN EMERGENCY DEPARTMENT PATIENTS.

2015 Critical Care Medicine

163. Clinical Decision Rules for Diagnostic Imaging in the Emergency Department: A Research Agenda. (PubMed)

Clinical Decision Rules for Diagnostic Imaging in the Emergency Department: A Research Agenda. Major gaps persist in the development, validation, and implementation of clinical decision rules (CDRs) for diagnostic imaging.The objective of this working group and article was to generate a consensus-based research agenda for the development and implementation of CDRs for diagnostic imaging in the emergency department (ED).The authors followed consensus methodology, as outlined by the journal (...) a successful CDR, 4) how should investigators best compare CDRs to clinical judgment, and 5) what disease states are amenable (and highest priority) to development of CDRs for diagnostic imaging in the ED?The concepts discussed herein demonstrate the need for further research on CDR development and implementation regarding diagnostic imaging in the ED. Addressing this research agenda should have direct applicability to patients, clinicians, and health care systems.© 2015 by the Society for Academic

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2015 Academic Emergency Medicine

164. Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients. (PubMed)

Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients. Despite low prevalence of pulmonary embolism (PE) in young adults, they are frequently imaged for PE, which involves radiation exposure and substantial financial cost.Determine the use and positive proportions for PE imaging by age, differences in clinical presentation of PE by age and the projected impact of an age-targeted decision rule.Analysis of two national population (...) proportion of positive examinations in young adults than older adults (2.3% vs 17.4%, p<0.001 in women; 4.0% vs 21.4%, p<0.001 in men). Clinical predictors of PE varied by age. Tachycardia was a significant predictor of PE in older patients (OR: 1.2-1.9, p<0.001), but not young patients. Fever was a significant predictor only in young patients (OR: 1.4-7.2, p<0.01). A modification of the previously described PERC rule to include age-specific risk factors could reduce PE imaging by 51% in young patients

2015 Emergency Medicine Journal

165. Failure of Prospective Validation and Derivation of a Refined Clinical Decision Rule for Chest Radiography in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome (PubMed)

Failure of Prospective Validation and Derivation of a Refined Clinical Decision Rule for Chest Radiography in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome The authors previously derived a clinical decision rule (CDR) for chest radiography in patients with chest pain and possible acute coronary syndrome (ACS) consisting of the absence of three predictors: history of congestive heart failure, history of smoking, and abnormalities on lung auscultation. The aim (...) %) and a negative predictive value of 100.0% (95% CI = 96.3% to 100.0%).Prospective validation of our previously derived CDR for clinically important chest radiographic abnormalities was not successful. Derivation of a refined rule identified all clinically important radiographic abnormalities, but was insufficiently specific. No CDR with adequate sensitivity and specificity could be found.© 2012 by the Society for Academic Emergency Medicine.

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2012 EvidenceUpdates

166. Model for prediction of pediatric OSA: Proposal for a clinical decision rule. (PubMed)

Model for prediction of pediatric OSA: Proposal for a clinical decision rule. Obstructive sleep apnea (OSA) is a syndrome frequently diagnosed in children; however, it lacks optimal diagnostic methods. This study aimed to provide a clinical decision rule for predicting pediatric OSA using commonly available clinical information.A prospective cohort study.Children between the ages of 3 to 6 years-old, referred for an otorhinolaryngology consultation due to clinical suspicion of OSA, were (...) OSA in the final model (odds ratio, 95% confidence interval) included PSQ score (5.12; 3.3-6.5), ODI (1.34; 1.0-1.79) and tonsil size (6.7; 3.22-9.75). The final decision rule had a sensitivity of 88% and a specificity of 86%. The area under the receiver operating characteristic curve was 0.897.The proposed clinical decision rule, based on three readily available variables, is a promising discriminating instrument for prediction of OSA among children between 3 and 6 years.2b.© 2015 The American

2015 Laryngoscope

167. Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain. (PubMed)

Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain. Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain.We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low-, medium-, and high-risk groups for chronic (...) pain.This is a prospective cohort study in primary care.Patients with acute low back pain (LBP, ≤30 days duration) were included.Outcome measures were self-reported perceived nonrecovery and chronic pain.Patients were surveyed at baseline, 6 months, and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical, and psychosocial variables for chronic pain outcomes, developed a CDR, and assessed its performance by calculating the bootstrapped areas under the receiver

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2015 The Spine Journal

168. Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature. (PubMed)

Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature. First-time peripheral intravenous catheter (PIVC) insertion success is dependent on patient, clinician, and product factors. Failed PIVC insertion are an under-recognized clinical phenomenon.To provide a scoping review of decision aids for PIVC insertion including tools, clinical prediction rules, and algorithms (TRAs (...) ) and their findings on factors associated with insertion success.In June 2016, a systematic literature search was performed using the medical subject heading of peripheral catheterization and tool* or rule* or algorithm*. Data extraction included clinician, patient, and/or product variables associated with PIVC insertion success. Information about TRA reliability, validity, responsiveness, and utility was also extracted.We screened 36 studies, and included 13 for review. Seven papers reported insertion success

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2017 Journal of Hospital Medicine

169. Stent placement for benign esophageal leaks, perforations, and fistulae: a clinical prediction rule for successful leakage control. (PubMed)

predictive value was 64 % and 86 %, respectively.This prediction rule, consisting of four clinical predictors, could identify patients with esophageal leaks who were likely to benefit from or fail on stent therapy. The prediction rule can support clinical decision-making when the predicted probability of success is ≥ 70 % or ≤ 50 %.© Georg Thieme Verlag KG Stuttgart · New York. (...) Stent placement for benign esophageal leaks, perforations, and fistulae: a clinical prediction rule for successful leakage control. Sealing esophageal leaks by stent placement allows healing in 44 % - 94 % of patients. We aimed to develop a prediction rule to predict the chance of successful stent therapy.In this multicenter retrospective cohort study, patients with benign upper gastrointestinal leakage treated with stent placement were included. We used logistic regression analysis including

2017 Endoscopy

170. Clinical prediction rules: Use the babies and throw the bathwater?

not a robot, don’t tell me what to do” effect, which I think raises a nice question: How then do these tools ideally fit within our practice? Despite the HIGHLY unfortunate nomenclature, clinical prediction RULES probably shouldn’t be considered rules at all (at least not in the dictatorial sense – perhaps in the statistical sense). They are designed to inform decision-making, and should not be a replacement for clinical reasoning. Finally, clinicians expected a degree of congruence between a CPR, its (...) , Bennett C. Implementation of Clinical Decision Rules in the Emergency Department. Academic Emergency Medicine. 2007;14(11):955-959. [4] Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet. 2011;378(9802):1560-1571. [5] Knox GM, Snodgrass SJ, Rivett DA. Physiotherapy clinical educators’ perceptions and experiences of clinical prediction rules. Physiotherapy. 2015;101

2017 Body in Mind blog

171. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. (PubMed)

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles (...) for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic

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2017 BMC Musculoskeletal Disorders

172. Feasibility of automatic evaluation of clinical rules in general practice. (PubMed)

of assessing and formalizing clinical rules for decision support. Clinical rules that satisfied the criteria outlined in the LERM method were judged to be implementable in automatic evaluation in general practice.Thirty-three out of 81 (40.7%) Dutch-translated ACOVE clinical rules can be automatically evaluated in electronic medical record systems. Seven out of 7 CRs (100%) in the domain of diabetes can be automatically evaluated, 9/17 (52.9%) in medication use, 5/10 (50%) in depression care, 3/6 (50 (...) Feasibility of automatic evaluation of clinical rules in general practice. To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluation of quality of care in general practice.We assessed 81 clinical rules (CRs) adapted from a subset of Assessing Care of Vulnerable Elders (ACOVE) clinical rules, against Dutch College of General Practitioners (NHG) data model. Each CR was analyzed using the Logical Elements Rule METHOD: (LERM). LERM is a stepwise method

2017 International journal of medical informatics

173. Graphics and statistics for cardiology: clinical prediction rules. (PubMed)

Graphics and statistics for cardiology: clinical prediction rules. Graphs and tables are indispensable aids to quantitative research. When developing a clinical prediction rule that is based on a cardiovascular risk score, there are many visual displays that can assist in developing the underlying statistical model, testing the assumptions made in this model, evaluating and presenting the resultant score. All too often, researchers in this field follow formulaic recipes without exploring (...) the issues of model selection and data presentation in a meaningful and thoughtful way. Some ideas on how to use visual displays to make wise decisions and present results that will both inform and attract the reader are given. Ideas are developed, and results tested, using subsets of the data that were used to develop the ASSIGN cardiovascular risk score, as used in Scotland.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http

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2017 Heart

174. Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study (PubMed)

Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department.We conducted a 6-year prospective cohort study in 4 university-affiliated (...) of age or older represented 25.3% (210/830) and 23.7% (131/552) of the derivation and validation cohorts, respectively. The final clinical decision rule included a combination of age (> 70 yr, 2 points; 45-70 yr, 1 point), fracture of any high to mid thorax rib (ribs 3-9, 2 points) and presence of 3 or more rib fractures (1 point). Twenty (30.8%) of the 65 high-risk patients (score ≥ 4) experienced hemothorax during the follow-up period. The clinical decision rule had a high specificity (90.7%, 95

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2017 CMAJ open

175. A rule-based electronic phenotyping algorithm for detecting clinically relevant cardiovascular disease cases (PubMed)

A rule-based electronic phenotyping algorithm for detecting clinically relevant cardiovascular disease cases The implementation of electronic medical records (EMR) is becoming increasingly common. Error and data loss reduction, patient-care efficiency increase, decision-making assistance and facilitation of event surveillance, are some of the many processes that EMRs help improve. In addition, they show a lot of promise in terms of data collection to facilitate observational epidemiological (...) studies and their use for this purpose has increased significantly over the recent years. Even though the quantity and availability of the data are clearly improved thanks to EMRs, still, the problem of the quality of the data remains. This is especially important when attempting to determine if an event has actually occurred or not. We sought to assess the sensitivity, specificity, and agreement level of a codes-based algorithm for the detection of clinically relevant cardiovascular (CaVD

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2017 BMC research notes

176. Design and implementation of electronic health record integrated clinical prediction rules (iCPR): a randomized trial in diverse primary care settings. (PubMed)

Design and implementation of electronic health record integrated clinical prediction rules (iCPR): a randomized trial in diverse primary care settings. Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous (...) single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems.The iCPR tool is based on two well-validated CPRs, one for strep

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2017 Implementation Science Controlled trial quality: uncertain

177. Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study. (PubMed)

Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study. In the nursing home population, it is estimated that 1 in every 3 patients is polymedicated and given their considerable frailty, these patients are especially prone to adverse drug reactions. Clinical pharmacist-led medication reviews are considered successful interventions to improve medication safety in the inpatient setting. Due to the limited available (...) evidence concerning the benefits of medication reviews performed in the nursing home setting, we propose a study aiming to demonstrate a positive effect that a clinical decision support system, as a health care intervention, may have on the target population. The primary objective of this study is to reduce the number of patients with at least one event when using the clinical decision support system compared to the regular care. These events consist of hospital referrals, delirium, falls

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2017 BMC Geriatrics Controlled trial quality: uncertain

178. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

patients to the risk of radiation. Biomarkers, in combination with clinical decision tools, could help to rule out intracranial injuries without CT investigations, saving CT use for those most at risk and thus, minimising unnecessary radiation exposure and resource use. METHODS A systematic review was performed to assess the diagnostic accuracy and economic value of biomarkers compared to CT scan, for intracranial injuries (ICI) in adults and children with mCT. RESULTS Most of the available evidence (...) ) scanning is used only in mCT patients whom clinicians assess as being at risk of intracranial lesions either on the basis of clinical decision rules and/or unstructured assessments a . CT scan is currently recognised as the gold standard b for diagnosis of ICI because of its wide availability and its sensitivity for intracranial lesions linked to cranial trauma. Nevertheless, it is an expensive procedure that exposes patients to the risk of radiation, making it important to carefully assess the need

2016 Belgian Health Care Knowledge Centre

179. AAP 2016 Top 10 #4: Clinical judgment vs PECARN Clinical prediction rule in TBI

better help rule out head injury than rule it in Especially in children very low risk for ciTBI the rules can supplement clinical judgment and help make the decision to NOT order a CT easier Children in which you are very worried have a ciTBI should get a CT (GCS <15, AMS, obvious skull fracture etc,.) By | 2016-12-14T12:56:35-04:00 December 2nd, 2016 | , | Share this post About the Author: Brad Sobolewski, MD, MEd is an Associate Professor of Pediatric Emergency Medicine and an Assistant Director (...) AAP 2016 Top 10 #4: Clinical judgment vs PECARN Clinical prediction rule in TBI AAP 2016 Top 10 #4: Clinical judgment vs PECARN Clinical prediction rule in TBI – PEMBlog Search for: Search for: AAP 2016 Top 10 #4: Clinical judgment vs PECARN Clinical prediction rule in TBI Comparison of Prediction Rules and Clinician Suspicion for Identifying Children With Clinically Important Brain Injuries After Blunt Head Trauma Atabaki SM, Hoyle JD Jr, Schunk JE, Monroe DJ, Alpern ER, Quayle KS, Glass TF

2016 PEM Blog

180. Methodologic Standards for Interpreting Clinical Decision Rules in Emergency Medicine: 2014 Update. (PubMed)

Methodologic Standards for Interpreting Clinical Decision Rules in Emergency Medicine: 2014 Update. Clinical decision rules are increasingly prominent in medicine, particularly in emergency care. The quality, use, and impact of current published decision rules widely vary, requiring clinicians to be critical consumers. We present an approach to assist in the appraisal of clinical decision rules and in judging when to use such rules. Copyright © 2014 American College of Emergency Physicians

2014 Annals of Emergency Medicine

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