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"HERDOO2" clinicaldecisionrule to guide duration of anticoagulation in women with unprovoked venous thromboembolism. Can I use any d-Dimer? The "HERDOO2 rule" is a prospectively validated clinicaldecisionrule 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 clinicaldecisionrule 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®
Validation and refinement of a clinicaldecisionrule 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 decisionrule, 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
ClinicalDecisionRules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines ClinicalDecisionRules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines | CADTH.ca Find the information you need ClinicalDecisionRules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines ClinicalDecisionRules 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 clinicaldecisionrules 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
Prospective validation of a clinicaldecisionrule 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 decisionrule 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
Increasing Complexity in Rule-Based ClinicalDecision 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 clinicaldecision 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
Derivation and validation of a clinicaldecisionrule 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 clinicaldecisionrule 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 clinicaldecisionrule 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
A simple clinicaldecisionrule 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 clinicaldecisionrule (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
The Massachusetts abscess rule: a clinicaldecisionrule 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 clinicaldecisionrule (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
Clinicaldecisionrules to rule out subarachnoid hemorrhage for acute headache. Three clinicaldecisionrules 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 decisionrule 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
Accuracy of the "traffic light" clinicaldecisionrule for serious bacterial infections in young children with fever: a retrospective cohort study. To determine the accuracy of a clinicaldecisionrule (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
Systematic review: diagnostic accuracy of clinicaldecisionrules 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.
How Accurate are ClinicalDecisionRules for Pediatric Minor Head Injury? SystematicReviewSnapshot TAKE-HOME MESSAGE The Pediatric Emergency Care Applied Research Network (PECARN) decisionrule 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 ClinicalDecisionRules 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
Performance of 4 ClinicalDecisionRules in the Diagnostic Management of Acute Pulmonary Embolism: A Prospective Cohort Study. Several clinicaldecisionrules (CDRs) are available to exclude acute pulmonary embolism (PE), but they have not been directly compared.To directly compare the performance of 4 CDRs (Wells rule, revised Geneva score, simplified Wells rule, and simplified revised Geneva score) in combination with d-dimer testing to exclude PE.Prospective cohort study.7 hospitals (...) Wells rule) to 72% (Wells rule). Combined with a normal d-dimer result, the CDRs excluded PE in 22% to 24% of patients. The total failure rates of the CDR and d-dimer combinations were similar (1 failure, 0.5% to 0.6% [upper-limit 95% CI, 2.9% to 3.1%]). Even though 30% of patients had discordant CDR outcomes, PE was not detected in any patient with discordant CDRs and a normal d-dimer result.Management was based on a combination of decisionrules and d-dimer testing rather than only 1 CDR combined
Comparing the diagnostic performance of 2 clinicaldecisionrules to rule out deep vein thrombosis in primary care patients The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinicaldecisionrule for primary care patients (the primary care rule) has been proposed, because the Wells rule is not sufficient to rule out DVT in this setting. The objective was to compare the ability (...) of both rules to safely rule out DVT and to efficiently reduce the number of referrals for leg ultrasound investigation that would result in a negative finding.Family physicians collected data on 1,086 patients to calculate the scores for both decisionrules before leg ultrasonography was performed. In all patients D-dimer (dimerized plasmin fragment D) testing was performed using a rapid point-of-care assay. Patients were stratified into risk categories defined by each rule and the D-dimer result
Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinicaldecisionrulesClinicaldecisionrules (CDRs) could be helpful to safely distinguish between bacterial and aseptic meningitis (AM).To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest.Secondary analysis of retrospective multicentre hospital-based cohort study.Six paediatric emergency or intensive care units of tertiary care (...) for the sensitivity of both rules, which can be used cautiously. However, use of the BMS could safely avoid significantly more unnecessary antibiotic treatments for children with AM than can the Meningitest in this population.