Appraisal of Early Evaluation of Blunt Chest Trauma: Development of a Standardized Scoring System for Initial Clinical Decision Making

Abstract PURPOSE Glioblastomas (GBM) are the most common primary brain tumour recurring in most patients despite maximal management. Patient selection for appropriate treatment modality remains challenging resulting in heterogeneity in management. We examined the patterns of failure and developed a scoring system for patient stratification to optimise clinical decision making. METHODS 822 adults (BC Cancer Agency registry) diagnosed 2005–2015 age ≥60 with histologically confirmed GBM ICD-O-3 codes (9440/3, 9441/3, 9442/3) were reviewed. Univariate and Kaplan-Meier analysis were performed. Performance status (PS), age and resection status were assigned a score, cummulative maximal (favorable) score of 10 and minimum (unfavorable) score of 3. Patterns of failure were further analysed in the subset of patients with radiographic follow-up. RESULTS PS score of 3(KPS >80, ECOG 0/1), 2 (KPS 60–70, ECOG 2), 1 (KPS < 60, ECOG 3/4) (median OS 11, 6, 3 months respectively), age score and resection status were prognostic for OS with PS resulting in the most significant curve separation (p< 0.0001). Biopsy as compared to STR/GTR resulted in poorer OS in patients over 70 (age score 1/2) but had less impact in patients younger than 70 (age scores 3/4). The median OS for cumulative scores of 9/10 (123 patients), 7/8 (286 patients), 5/6 (313 patients), and 3/4 (55 patients) were 14, 8, 4 and 2 months respectively (p< 0.0001) allowing for stratification into 4 prognostic groups. 133 patients had >3 MRIs following diagnosis allowing for clinical and radiographic analysis of progression. Clinical/radiographic progression occurred within 3 months (29%/45%), 6 months (50%/66%), 9 months (70%/81%). Progression type (radiographic, clinical, both was not associated with OS. CONCLUSION Our novel prognostic scoring system is effective in achieving patient stratification and may guide clinical decision making. Early radiographic progression appears to precede clinical deterioration and may represent true progression in the elderly.

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890 Predictive Factors for Mortality Following Trauma & Orthopaedic Surgery in The Covid-19 Pandemic. The Manchester Equation

British Journal of Surgery ◽

10.1093/bjs/znab134.094 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C Waugh ◽

N Jain ◽

A Bhutta ◽

T Havenhand ◽

M Qureshi ◽

...

Keyword(s):

Decision Making ◽

Mortality Rate ◽

Predictive Factors ◽

Mortality Risk ◽

Scoring System ◽

Orthopaedic Surgery ◽

Clinical Decision Making ◽

Surgical Intervention ◽

Clinical Decision ◽

Surgical Mortality

Abstract Introduction Covid-19 caused many service changes including limitations on operations due to potential increased mortality risk to patients. We report our findings from Trauma & Orthopaedic (T&O) surgical mortality through this period and the effectiveness of using a scoring system (The Manchester Equation) to predict likelihood of mortality. Method We reviewed all T&O admissions that underwent surgical intervention during the height of the pandemic. We recorded numerous factors for each patient including mortality and Covid status. From this we created a scoring system which is the product of Covid status, Anaesthetic type, Medical co-morbidities and other medical factors and ASA Score. We then analysed the findings to determine whether the score could be predictive of mortality rate. Results Of 123 patients undergoing surgery 6 deaths were observed (mean score of 51.3) compared to 117 patients surviving (mean score 31.9), p = 0.001. A score of less than 32 carried a 0% chance of death whereas a score of 32 or more resulted in a 14.6% mortality rate (p = 0.01). Conclusion The Manchester Equation can be used to help predict the mortality rate of T&O surgery in the presence of Covid-19 and may be useful for clinical decision making and consent purposes.

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A new severity scoring system designed for the management of adult spinal tuberculosis—a retrospective case series study

10.21203/rs.2.22493/v1 ◽

2020 ◽

Author(s):

Qi Wang ◽

Xiaobo Luo ◽

Chi Wang ◽

Wenhao Hu ◽

Litao Li ◽

...

Keyword(s):

Decision Making ◽

Spinal Cord ◽

Scoring System ◽

Clinical Decision Making ◽

Spinal Tuberculosis ◽

Case Series ◽

Reliability And Validity ◽

Clinical Decision ◽

Severity Scoring ◽

Case Series Study

Abstract Background: Surgeons have been successfully handle with spinal tuberculosis via conservative or surgical treatment. However, There are quite few classifications or scoring systems concerning spinal tuberculosis to guide the surgeons to manage the complicated pattern of spinal tuberculosis. The purpose of this study is to design a practical, yet comprehensive, severity scoring system for spinal tuberculosis that helps in clinical decision-making in terms of the need for operative versus non-operative management.Methods: A group of 129 spinal tuberculosis cases (70 male and 59 female patients) successfully treated and followed up for at least 2 years were retrospectively reviewed. Clinical spine experts from our institutions were gathered to confirm the information they considered pivotal in the communication of spinal tuberculosis and the clinical decision-making process. Typical spinal tuberculosis patterns were reviewed and reconsidered in view of these essential characteristics. An initial validation process to determine the reliability and validity of this system was also undertaken. Results: A new severity scoring system was designed based on three essential characteristics: 1) the stability of spinal infectious segments determined by imaging appearance, 2) the cause of spinal cord compression and the severity of neurologic deficit, and 3) the efficacy of the anti-tuberculosis drug therapy. A severity score was calculated from these characteristics, which divided patients into surgical and nonsurgical treatment groups. Conclusions: The severity scoring system comprehensively considers features cited in the literature including prediction of spinal stability and kyphosis deformity progression, identification of neurologic compromise and characteristics of mechanical compression of spinal cord. This classification system is intended to facilitate clinical decision-making in the management of adult spinal tuberculosis (from C3 to L5 segments) . The severity scoring system may help to improve the communication among spine surgeons. Further studies are needed to determine the reliability and validity of this system.

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Clinical Decision Making and Oral Motor Treatments

ASHA Leader ◽

10.1044/leader.ftr3.10082005.8 ◽

2005 ◽

Vol 10 (8) ◽

pp. 8-35 ◽

Cited By ~ 9

Author(s):

Heather M. Clark

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Oral Motor

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Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

2011 ◽

Vol 20 (4) ◽

pp. 121-123

Author(s):

Jeri A. Logemann

Keyword(s):

Decision Making ◽

Patient Care ◽

Clinical Outcomes ◽

Clinical Judgment ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Method ◽

Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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