Latest & greatest articles for Clinical Decision Rule

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Top results for Clinical Decision Rule

1. "HERDOO2" clinical decision rule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer?

"HERDOO2" clinical decision rule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer? The "HERDOO2 rule" is a prospectively validated clinical decision rule used to identify low-risk women who can safely discontinue anticoagulants after completing 5-12 months of anticoagulant treatment for unprovoked venous thromboembolism. The VIDAS®d-Dimer (DD) assay, a component of the rule, was used in the derivation and validation of the rule at half (...) , -0.004-0.07)).The "HERDOO2 rule" is the only prospectively validated clinical decision rule that can be used to identify low-risk women with unprovoked venous thrombosis who can safely discontinue anticoagulants. An important implementation issue is whether any commercial DD assay can be used in the HERDOO2 rule, and at what cut-point. Our analysis shows that the HemosIL®, Innovance®, Liatest® and Tina-quant® DD assays should not be used in the "HERDOO2" rule due to poor concordance with the VIDAS®

2018 EvidenceUpdates

2. Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department (PubMed)

Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head (...) injury.This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Phys icians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test

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2018 EvidenceUpdates

3. Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines

Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines | CADTH.ca Find the information you need Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines Clinical Decision Rules and Strategies (...) for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines Last updated: May 23, 2018 Project Number: RC0982-000 Product Line: Research Type: Other Diagnostics Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical utility of clinical decision rules for the initial screening of patients with suspected group A strep infection? What are the evidence-based guidelines regarding the diagnosis of suspected group A strep infection? Key

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

4. The REFER (REFer for EchocaRdiogram) study: a prospective validation and health economic analysis of a clinical decision rule, NT-proBNP or their combination in the diagnosis of heart failure in primary care

The REFER (REFer for EchocaRdiogram) study: a prospective validation and health economic analysis of a clinical decision rule, NT-proBNP or their combination in the diagnosis of heart failure in primary care The REFER (REFer for EchocaRdiogram) study: a prospective validation and health economic analysis of a clinical decision rule, NT-proBNP or their combination in the diagnosis of heart failure in primary care Journals Library An error occurred retrieving content to display, please try again

2017 NIHR HTA programme

5. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring (PubMed)

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency (...) department.We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months. We collected standardized baseline characteristics, findings from clinical evaluations and predictors for the Ottawa Chest Pain Cardiac Monitoring Rule: whether the patient is currently free of chest pain, and whether the electrocardiogram is normal or shows only nonspecific changes. The outcome was an arrhythmia requiring

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2017 EvidenceUpdates

6. Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention (PubMed)

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care.The objective (...) of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care.This study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived

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2016 JMIR medical informatics

7. 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 (PubMed)

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

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2016 EvidenceUpdates

8. Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation

Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation Journals Library An error occurred retrieving content to display (...) , 1 Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK 2 Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK 3 Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK 4 Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK * Corresponding author Email: {{metadata.Journal

2016 NIHR HTA programme

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

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

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2015 EvidenceUpdates

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

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

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2014 EvidenceUpdates

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

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

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2014 EvidenceUpdates

12. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. (PubMed)

Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. Three clinical decision rules were previously derived to identify patients with headache requiring investigations to rule out subarachnoid hemorrhage.To assess the accuracy, reliability, acceptability, and potential refinement (ie, to improve sensitivity or specificity) of these rules in a new cohort of patients with headache.Multicenter cohort study conducted at 10 university-affiliated Canadian tertiary care (...) (6.2%) had subarachnoid hemorrhage. The decision rule including any of age 40 years or older, neck pain or stiffness, witnessed loss of consciousness, or onset during exertion had 98.5% (95% CI, 94.6%-99.6%) sensitivity and 27.5% (95% CI, 25.6%-29.5%) specificity for subarachnoid hemorrhage. Adding "thunderclap headache" (ie, instantly peaking pain) and "limited neck flexion on examination" resulted in the Ottawa SAH Rule, with 100% (95% CI, 97.2%-100.0%) sensitivity and 15.3% (95% CI, 13.8%-16.9

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2013 JAMA

13. Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study. (PubMed)

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

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2013 BMJ

14. 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

15. Systematic review: diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly

Systematic review: diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.

2012 DARE.

16. How Accurate are Clinical Decision Rules for Pediatric Minor Head Injury?

How Accurate are Clinical Decision Rules for Pediatric Minor Head Injury? SystematicReviewSnapshot TAKE-HOME MESSAGE The Pediatric Emergency Care Applied Research Network (PECARN) decision rule is very sensitive for detecting clinically important brain injury in children with minor head trauma. METHODS DATA SOURCES Investigators searched MEDLINE (to March 2010), EMBASE, CINAHL, and CENTRAL (to April 2009), the Web of Knowledge’s Science Citation In- dex, Social Science Citation Index (...) studies. Al- though the investigators planned to perform a meta-analysis of rules that were independently validated, only a systematic review without pooling results was feasible. How Accurate Are Clinical Decision Rules for Pediatric Minor Head Injury? EBEM Commentators Kelly Medwid, MD New York University School of Medicine/Bellevue Hospital Center Department of Emergency Medicine New York, NY Gene G. Couri, MD OSF Saint Francis Medical Center Peoria, IL Results Of the 14 cohorts studying children

2012 Annals of Emergency Medicine Systematic Review Snapshots

17. Systematic review: Clinical decision rules for the assessment of mild head injury, used in combination with clinical judgment, can inform the use of head imaging

Systematic review: Clinical decision rules for the assessment of mild head injury, used in combination with clinical judgment, can inform the use of head imaging Clinical decision rules for the assessment of mild head injury, used in combination with clinical judgment, can inform the use of head imaging | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn (...) more about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Clinical decision rules for the assessment of mild head injury, used in combination

2012 Evidence-Based Medicine (Requires free registration)

18. Clinical decision rules for excluding pulmonary embolism: a meta-analysis

Clinical decision rules for excluding pulmonary embolism: a meta-analysis Clinical decision rules for excluding pulmonary embolism: a meta-analysis Clinical decision rules for excluding pulmonary embolism: a meta-analysis Lucassen W, Geersing GJ, Erkens PM, Reitsma JB, Moons KG, Buller H, van Weert HC CRD summary This review concluded that clinical decision rules or Gestalt could safely exclude pulmonary embolism, when combined with sensitive D-dimer testing. Standardised decision rules were (...) recommended over Gestalt. The review was generally well conducted, but the conclusions and implications for practice seem to be too strong for the evidence presented. Authors' objectives To compare the failure rates of standard clinical assessment (Gestalt) and clinical decision rules, when used in combination with D-dimer testing, to diagnose pulmonary embolism in adults with suspected pulmonary embolism. Searching MEDLINE and EMBASE were searched for articles published in English, French, German

2011 DARE.

19. Clinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis. (PubMed)

Clinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis. Clinical probability assessment is combined with d-dimer testing to exclude pulmonary embolism (PE).To compare the test characteristics of gestalt (a physician's unstructured estimate) and clinical decision rules for evaluating adults with suspected PE and assess the failure rate of gestalt and rules when used in combination with d-dimer testing.Articles in MEDLINE and EMBASE in English, French, German, Italian, Spanish (...) , or Dutch that were published between 1966 and June 2011.3 reviewers, working in pairs, selected prospective studies in consecutive patients suspected of having PE. Studies had to estimate the probability of PE by using gestalt or a decision rule and verify the diagnosis by using an appropriate reference standard.Data on study characteristics, test performance, and prevalence were extracted. Reviewers constructed 2 × 2 tables and assessed the methodological quality of the studies.52 studies, comprising

2011 Annals of Internal Medicine

20. Clinical decision rules for adults with minor head injury: a systematic review (PubMed)

Clinical decision rules for adults with minor head injury: a systematic review There are many clinical decision rules for adults with minor head injury, but it is unclear how they compare in terms of diagnostic accuracy. This study aimed to systematically identify clinical decision rules for adults with minor head injury and compare the estimated diagnostic accuracies for any intracranial injury and injury requiring neurosurgical intervention.Several electronic bibliographic databases covering (...) biomedical, scientific, and gray literature were searched from inception to March 2010. At least two independent reviewers determined the eligibility of cohort studies that described a clinical decision rule to identify adults with minor head injury (Glasgow Coma Scale score, 13-15) at risk of intracranial injury or injury requiring neurosurgical intervention.Twenty-two relevant studies were identified. Differences existed in patient selection, outcome definition, and reference standards used. Nine rules

2011 EvidenceUpdates