scholarly journals National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 639-647 ◽  
Author(s):  
Kasim Abdulaziz ◽  
Jamie Brehaut ◽  
Monica Taljaard ◽  
Marcel Émond ◽  
Marie-Josée Sirois ◽  
...  
Keyword(s):  
High Risk ◽  
Decision Rule ◽  
Functional Decline ◽  
Clinical Decision ◽  
Screening Tools ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Clinical Decision Rule ◽  
Minor Injury ◽  
Elderly Trauma Patients

AbstractBackgroundThere are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury.MethodsAfter a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman’s Tailored Design Method.ResultsOf 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks.ConclusionsA drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.

scholarly journals Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

CJEM ◽  
2002 ◽  
Vol 4 (02) ◽  
pp. 84-90 ◽  
Author(s):  
Ian G. Stiell ◽  
George A. Wells ◽  
R. Douglas McKnight ◽  
Robert Brison ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Decision Rules ◽  
Clinical Decision ◽  
Evidence Based ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Clinical Decision Rule ◽  
Clinical Decision Rules ◽  
Ct Head ◽  
Cervical Spine Radiography ◽  
Evidence Based Guidelines

ABSTRACTThis paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study.

scholarly journals Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 281-287 ◽  
Author(s):  
Benoit Carrière ◽  
Karine Clément ◽  
Jocelyn Gravel
Keyword(s):  
Young Children ◽  
Decision Rule ◽  
Head Trauma ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Minor Head Trauma ◽  
Emergency Physicians ◽  
Clinical Decision Rule ◽  
Skull Radiographs

ABSTRACTBackground:Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologic evaluation in such cases.Objective:To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases.Design/Methods:A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval.Results:A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%.Conclusion:Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted.

scholarly journals The SCRAP rule: The Derivation and Internal Validation of a Clinical Decision Rule for Computed Tomography of the Chest in Blunt Thoracic Trauma

CJEM ◽  
2012 ◽  
Vol 14 (06) ◽  
pp. 344-353 ◽  
Author(s):  
Julien Payrastre ◽  
Suneel Upadhye ◽  
Andrew Worster ◽  
Daren Lin ◽  
Kamyar Kahnamoui ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Likelihood Ratio ◽  
Decision Rule ◽  
Negative Likelihood Ratio ◽  
Clinical Decision ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Validation Group ◽  
Clinical Decision Rule ◽  
Gcs Score

ABSTRACTObjective:To derive and internally validate a clinical decision rule that will rule out major thoracic injury in adult blunt trauma patients, reducing the unnecessary use of chest computed tomographic (CT) scans.Methods:Data were retrospectively obtained from a chart review of all trauma patients presenting to a Canadian tertiary trauma care centre from 2005 to 2008, with those from April 2006 to March 2007 being used for the validation phase. Patients were included if they had an Injury Severity Score > 12 and chest CT at admission or a documented major thoracic injury noted in the trauma database. Patients with penetrating injury, a Glasgow Coma Scale (GCS) score ≤ 8, paralysis, or age < 16 years were excluded.Results:There were 434 patients in the derivation group and 180 in the validation group who met the inclusion criteria. Using recursive partitioning, five clinical variables were found to be particularly predictive of injury. When these variables were normal, no patients had a major thoracic injury (sensitivity 100% [95% CI 98.4–100], specificity 46.9% [95% CI 44.2–46.9], and negative likelihood ratio 0.00 [95% CI 0.00–0.04]). The five variables were oxygensaturation (< 95% on room air or < 98% on any supplemental oxygen),chest radiograph, respiratoryrate ≥ 25, chestauscultation, and thoracicpalpation (SCRAP). In the validation group, the same five variables had a sensitivity of 100% (95% CI 96.2–100%), a specificity of 44.7% (95% CI 39.5–44.7%), and negative likelihood ratio of 0.00 (95% CI 0.00–0.10).Conclusions:In major blunt trauma with a GCS score > 8, the SCRAP variables have a 100% sensitivity for major thoracic injury in this retrospective study. These findings need to be prospectively validated prior to use in a clinical setting.

scholarly journals A clinical decision rule for cervical spine CT in head or neck trauma patients

2013 ◽  
Vol 24 (4) ◽  
pp. 192-199 ◽  
Author(s):  
Takeshi Inagaki ◽  
Akio Kimura ◽  
Akiyoshi Hagiwara ◽  
Ryo Sasaki ◽  
Takuro Shimbo
Keyword(s):  
Cervical Spine ◽  
Decision Rule ◽  
Clinical Decision ◽  
Trauma Patients ◽  
Clinical Decision Rule ◽  
Neck Trauma ◽  
Spine Ct

scholarly journals LO051: Validation of a clinical decision rule to detect patients with adverse drug events in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S47-S48
Author(s):  
C.M. Hohl ◽  
K. Badke ◽  
M.E. Wickham ◽  
A. Zhao ◽  
M. Sivilotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Decision Rule ◽  
Adverse Drug Events ◽  
Medical Condition ◽  
Tertiary Care ◽  
Risk Groups ◽  
Clinical Decision ◽  
Clinical Decision Rule ◽  
Management Interventions

Introduction: Adverse drug events (ADE) are a leading cause of emergency department (ED) visits, yet are missed in up to 50% of presentations. In 2014, Accreditation Canada, a not-for-profit organization that evaluates healthcare institutions based on quality of care, introduced a requirement for EDs to identify patients at high-risk for drug-related morbidity, so that medication management interventions can be targeted to high-risk groups. We derived a clinical decision rule to identify patients at high-risk for ADEs using 4 variables. Our objective was to validate the rule by determining its sensitivity and specificity in a new sample. Methods: We conducted a prospective observational study in two tertiary care and one urban community hospital in British Columbia and Ontario. We used a systematic selection algorithm to generate a representative sample, and enrolled adults who reported taking at least one medication during the prior two weeks. Nurses completed the clinical decision rule and evaluated patients for standardized clinical findings. Each patient was assessed by a research pharmacist and a physician who were blinded to data collected by nurses. Any disagreement was subsequently adjudicated by an independent committee. The primary outcome was an ADE, defined as an unintended and harmful event related to medication use resulting a change in medical management, hospital admission or causing death. We calculated the rule’s sensitivity, specificity, and the proportion of patients screening positive with 95% confidence intervals (CI). Results: Among 1529 enrolled patients, 196 (12.8%, 95% CI 11.2-14.6%) were deemed to have experienced an ADE. The rule, consisting of the variables (i) having a pre-existing medical condition or having taken antibiotics within one week, and (ii) age ≥ 80 or having a medication change within 28 days, had a sensitivity of 92.9% (95%CI 88.3%-96.0%) and a specificity of 35.0% (95%CI 32.5%-37.7%) for ADEs. The proportion of patients screening positive was 41.7%. Conclusion: Among adults presenting to EDs, the rule was sensitive for ADEs while maintaining reasonable specificity. If implemented, the rule may help identify those patients at high-risk for ADEs who may benefit from evaluation by a clinical pharmacist in the ED, and will help institutions meet current Accreditation Canada standards.

scholarly journals Refinement of the Quebec decision rule for radiography in shoulder dislocation

CJEM ◽  
2009 ◽  
Vol 11 (01) ◽  
pp. 36-43 ◽  
Author(s):  
Marcel Émond ◽  
Natalie Le Sage ◽  
André Lavoie ◽  
Lynne Moore
Keyword(s):  
High Risk ◽  
Decision Rule ◽  
Shoulder Dislocation ◽  
Motor Vehicle ◽  
Negative Likelihood Ratio ◽  
Clinical Decision ◽  
Absolute Number ◽  
Fracture Dislocation ◽  
Clinical Decision Rule ◽  
Glenohumeral Dislocation

ABSTRACTObjective:We prospectively derived a clinical decision rule to guide pre- and postreduction radiography for emergency department (ED) patients with anterior glenohumeral dislocation.Methods:This prospective cohort derivation study took place at 4 university-affiliated EDs over a 3-year period and enrolled consenting patients with anterior glenohumeral dislocation who were 18 years of age or older. We compared patients with a clinically important fracture-dislocation with those who had an uncomplicated dislocation to provide the clinical decision rule components using recursive partitioning. The final rule involved age, mechanism, prior dislocation and humeral ecchymosis.Results:A total of 222 patients were included in the study. Forty (18.0%) had clinically important fracture-dislocation. A clinical decision rule using 4 factors reached a sensitivity of 100% (95% confidence interval [CI] 89.4%–100%), a specificity of 34.2% (95% CI 27.7%–41.2%), a negative predictive value of 99.2% (95% CI 92.8%–99.9%) and a negative likelihood ratio of 0.04 (95% CI 0.002–0.27). Patients younger than 40 years are at high risk for clinically important fracture-dislocation only if the mechanism of injury involves substantial force (i.e., a fall greater than their own height, a sport injury, an assault or a motor vehicle collision). Patients 40 years of age or older are at high risk only in the presence of humeral ecchymosis or after their first dislocation. Projected use of the rule would reduce the absolute number of prereduction radiographs by 27.9% and of postreduction by 81.9%.Conclusion:The Quebec shoulder dislocation rule for patients with acute anterior glenohumeral dislocation holds promise to reduce unnecessary imaging, pending validation.

A clinical decision rule and D-dimer testing to rule out upper extremity deep vein thrombosis in high-risk patients

2016 ◽  
Vol 148 ◽  
pp. 59-62 ◽  
Author(s):  
Nick van Es ◽  
Suzanne M Bleker ◽  
Marcello Di Nisio ◽  
Ankie Kleinjan ◽  
Jan Beyer-Westendorf ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Decision Rule ◽  
Clinical Decision ◽  
Clinical Decision Rule ◽  
Vein Thrombosis ◽  
Risk Patients ◽  
Deep Vein ◽  
D Dimer ◽  
Rule Out
Sign in / Sign up

Export Citation Format

Share Document