P051: Does knowledge of the Canadian CT Head Rules impact the frequency of CT’s ordered?

Introduction: The Canadian Computed Tomography Head Rules (CCTHR) is a validated and well-known head injury clinical decision rule that allows Emergency Room Physicians (ERPs) to determine which patients are most likely to benefit from a diagnostic CT. However, this clinical decision rule is not uniformly adhered to and a number of preventable CT scans are ordered. Choosing Wisely Canada has ranked decreasing unnecessary head CT scans as the number one priority for Emergency Departments (ED). As such, the purpose of this study was to investigate if an educational intervention for ERPs would increase adherence to the CCTHR. Methods: In September 2015 the CCTHR were presented and discussed at three ED departmental meetings at Kelowna General Hospital (KGH) a large tertiary hospital in the interior of British Columbia, Canada. Educational materials were distributed to the ERPS and a CTTHR checklist was made available throughout the ED. Rates of adherence to the CCTHR criteria were calculated from MHI patients that were seen in the four years prior to the educational intervention and were compared to rates of adherence for patients 12 months post educational intervention. Only patients that agreed to participate in the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were included in this analysis. Differences in adherence rates were tested using the chi-squared test. Results: 477 patients were included in the analysis for the pre-education cohort (control) and 257 for the post-education cohort(intervention). In the control cohort, 348 of the 477 (73%) of the patients were managed in accordance to the CCTHR compared to 194 of the 257 (75%) in the intervention cohort. There was no statistically significant difference in rates of adherence (p=0.457).In the control cohort, 44 of the 321 (14%) of patients received a CT that did not meet any CCTHR criteria compared to 15 of the 163 (9%) in the intervention cohort. The overall CT imaging rate was 24% in each patient cohort. Conclusion: Although adherence rates between the two cohorts were not statistically different, a greater proportion of patients had a CTAS of 2 or 3 and met criteria in the intervention cohort suggesting a higher level of acuity. Imaging rates remained constant at 24%, which was lower than expected if there was full adherence to the CCTHR. Further study is required to determine if educational interventions can improve adherence to the CCTHR.

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G93(P) Does the TEN4 clinical decision rule distinguish bruises from physical abuse from inherited bleeding disorders and accidental injury?

10.1136/archdischild-2019-rcpch.91 ◽

2019 ◽

Author(s):

AM Kemp ◽

S Maguire ◽

D Farewell ◽

D Nuttall ◽

P Collins ◽

...

Keyword(s):

Physical Abuse ◽

Decision Rule ◽

Clinical Decision ◽

Bleeding Disorders ◽

Clinical Decision Rule ◽

Accidental Injury

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Predictors Of In-Hospital Mortality Among Patients Identified As Having Severe Sepsis By An Automated Clinical Decision Rule

10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4696 ◽

2011 ◽

Author(s):

Joe K. Gerald ◽

Jorge Alsip ◽

Joan Hicks ◽

Michael R. Waldrum ◽

Nancy E. Dunlap

Keyword(s):

Severe Sepsis ◽

Hospital Mortality ◽

Decision Rule ◽

Clinical Decision ◽

Clinical Decision Rule

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Computer-Assisted Categorizing of Head Computed Tomography Reports for Clinical Decision Rule Research

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2006.06.031 ◽

2006 ◽

Vol 48 (5) ◽

pp. 551-557.e25

Author(s):

Stephen P. Wall ◽

Oliver Mayorga ◽

Christine E. Banfield ◽

Mark E. Wall ◽

Ilan Aisic ◽

...

Keyword(s):

Computed Tomography ◽

Decision Rule ◽

Clinical Decision ◽

Computer Assisted ◽

Clinical Decision Rule ◽

Head Computed Tomography

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Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open ◽

10.1136/bmjopen-2020-040361 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040361

Author(s):

Amanda Klinger ◽

Ariel Mueller ◽

Tori Sutherland ◽

Christophe Mpirimbanyi ◽

Elie Nziyomaze ◽

...

Keyword(s):

Decision Making ◽

Quality Improvement ◽

Clinical Decision Making ◽

Clinical Decision ◽

Tertiary Hospital ◽

Early Warning Score ◽

Receiver Operating Curve ◽

Predictive Capacity ◽

Suspected Infection ◽

Significant Difference

RationaleMortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.ObjectiveTo determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.Design, setting, participants and outcome measuresWe prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.ResultsWe screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.ConclusionThree scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

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Alternative diagnosis other than pulmonary embolism as a subjective variable in the Wells clinical decision rule: not so bad after all

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2007.02475.x ◽

2007 ◽

Vol 5 (5) ◽

pp. 1079-1080 ◽

Cited By ~ 14

Author(s):

F. A. KLOK ◽

R. KARAMI DJURABI ◽

M. NIJKEUTER ◽

M. V. HUISMAN

Keyword(s):

Pulmonary Embolism ◽

Decision Rule ◽

Clinical Decision ◽

Clinical Decision Rule ◽

Alternative Diagnosis

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Independent Evaluation of an Out-of-hospital Termination of Resuscitation (TOR) Clinical Decision Rule

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2008.00110.x ◽

2008 ◽

Vol 15 (6) ◽

pp. 517-521 ◽

Cited By ~ 46

Author(s):

Peter B. Richman ◽

Tyler F. Vadeboncoeur ◽

Vatsal Chikani ◽

Lani Clark ◽

Bentley J. Bobrow

Keyword(s):

Decision Rule ◽

Clinical Decision ◽

Clinical Decision Rule ◽

Independent Evaluation

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Re: Is there a need for a clinical decision rule in blunt wrist trauma?

Injury ◽

10.1016/j.injury.2013.09.033 ◽

2014 ◽

Vol 45 (11) ◽

pp. 1798-1799 ◽

Cited By ~ 5

Author(s):

M.M.J. Walenkamp ◽

N.W.L. Schep

Keyword(s):

Decision Rule ◽

Clinical Decision ◽

Clinical Decision Rule ◽

Wrist Trauma

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Implementing Clinical Pharmacogenomics in the Classroom: Student Pharmacist Impressions of an Educational Intervention Including Personal Genotyping

Pharmacy ◽

10.3390/pharmacy6040115 ◽

2018 ◽

Vol 6 (4) ◽

pp. 115 ◽

Cited By ~ 5

Author(s):

Amber Frick ◽

Cristina Benton ◽

Oscar Suzuki ◽

Olivia Dong ◽

Rachel Howard ◽

...

Keyword(s):

Educational Intervention ◽

Clinical Decision Making ◽

Clinical Decision ◽

Educational Interventions ◽

Rank Test ◽

Drug Dosing ◽

Signed Rank ◽

Signed Rank Test ◽

Students Attitudes ◽

Personalized Approach

Pharmacogenomics provides a personalized approach to pharmacotherapy by using genetic information to guide drug dosing and selection. However, partly due to lack of education, pharmacogenomic testing has not been fully implemented in clinical practice. With pharmacotherapy training and patient accessibility, pharmacists are ideally suited to apply pharmacogenomics to patient care. Student pharmacists (n = 222) participated in an educational intervention that included voluntary personal genotyping using 23andMe. Of these, 31% of students completed both pre- and post-educational interventions to evaluate their attitudes and confidence towards the use of pharmacogenomics data in clinical decision making, and 55% of this paired subset obtained personal genotyping. McNemar’s test and the Wilcoxon signed-rank test were used to analyze responses. Following the educational intervention, students regardless of genotyping were more likely to recommend personal genotyping (36% post-educational intervention versus 19% pre-educational intervention, p = 0.0032), more confident in using pharmacogenomics in the management of drug therapy (51% post-educational intervention versus 29% pre-educational intervention, p = 0.0045), and more likely to believe that personalized genomics would have an important role in their future pharmacy career (90% post-educational intervention versus 51% pre-educational intervention, p = 0.0072) compared to before receiving the educational intervention. This educational intervention positively influenced students’ attitudes and confidence regarding pharmacogenomics in the clinical setting. Future studies will examine the use of next-generation sequencing assays that selectively examine pharmacogenes in the education of student pharmacists.

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