scholarly journals The diagnostic certainty levels of junior clinicians: A retrospective cohort study

2021 ◽  
pp. 183335832110191
Author(s):  
Yang Chen ◽  
Myura Nagendran ◽  
Yakup Kilic ◽  
Dominic Cavlan ◽  
Adam Feather ◽  
...  
Keyword(s):  
Cohort Study ◽  
Focus Group ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physical Sign ◽  
Course Of Action ◽  
Diagnostic Certainty ◽  
Patient Opinion

Background: Clinical decision-making is influenced by many factors, including clinicians’ perceptions of the certainty around what is the best course of action to pursue. Objective: To characterise the documentation of working diagnoses and the associated level of real-time certainty expressed by clinicians and to gauge patient opinion about the importance of research into clinician decision certainty. Method: This was a single-centre retrospective cohort study of non-consultant grade clinicians and their assessments of patients admitted from the emergency department between 01 March 2019 and 31 March 2019. De-identified electronic health record proformas were extracted that included the type of diagnosis documented and the certainty adjective used. Patient opinion was canvassed from a focus group. Results: During the study period, 850 clerking proformas were analysed; 420 presented a single diagnosis, while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign and 16 (4%) were laboratory-result-defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. The patient focus group were unanimous in their support of this research. Conclusion: The documentation of working diagnoses is highly variable among non-consultant grade clinicians. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses. Implications: Increased standardisation of documentation will help future studies to better analyse and quantify diagnostic certainty in both single and multiple working diagnoses. This could lead to subsequent examination of their association with important process or clinical outcome measures.

scholarly journals Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045895
Author(s):  
Rebecca Sharp ◽  
Peter Carr ◽  
Jessie Childs ◽  
Andrew Scullion ◽  
Mark Young ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Outcome Measure ◽  
Diagnostic Group ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Characteristic Analysis

ObjectivesDetermine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group.DesignRetrospective cohort study.Setting4 tertiary hospitals in Australia and New Zealand.ParticipantsAdults who had undergone PICC insertion.Primary outcome measureSymptomatic thrombus of the limb in which the PICC was inserted.Results2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions.ConclusionsAdherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.

scholarly journals The diagnostic certainty levels of junior clinicians: A retrospective cohort study

2020 ◽  
Author(s):  
Yang Chen ◽  
Myura Nagendran ◽  
Yakup Kilic ◽  
Dominic Cavlan ◽  
Adam Feather ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Laboratory ◽  
Physical Sign ◽  
Laboratory Result ◽  
Electronic Health Record Data ◽  
Diagnostic Uncertainty ◽  
Diagnostic Certainty

ABSTRACT Purpose of the Study To characterise the documentation of working diagnoses and their associated level of certainty by clinicians assessing patients referred to the medical team from the emergency department. Design This was a single centre retrospective cohort study of non-consultant grade clinicians at the Royal London Hospital, Barts Health NHS Trust between 01/03/19 to 31/03/19. De-identified electronic health record data was collected to include the type of diagnosis documented (clinical, laboratory result or symptom/sign defined) and the certainty adjective used for single diagnoses. Presence or absence of diagnostic uncertainty was collected for multiple diagnoses. Results 865 medical assessments were recorded during the study period. 850 were available for further analysis. 420 presented a single diagnosis while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign, and 16 (4%) were laboratory-result defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. Conclusion The documentation of working diagnoses is highly variable amongst non-consultant grade clinicians assessing patients admitted via the emergency department. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses however documentation style was heterogenous. These data have implications for prospective studies examining the quantification of diagnostic certainty and its association with important process or outcome measures.

scholarly journals Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5248
Author(s):  
Naoki Yogo ◽  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
...  
Keyword(s):  
Cohort Study ◽  
Head Injury ◽  
Diagnostic Accuracy ◽  
Decision Rule ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Characteristic Curve ◽  
Clinical Decision ◽  
The Novel ◽  
Clinical Decision Rule

Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; p = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.

scholarly journals Incidences and risk factors of serious infections among different rheumatic patients: a retrospective cohort study

2020 ◽  
Author(s):  
Jin Ding ◽  
Yang Xiang ◽  
Yujia Zhou ◽  
Cong Zhu ◽  
Xinyue Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Rheumatic Diseases ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Decision Making ◽  
Cox Model ◽  
Infection Rates ◽  
Serious Infections ◽  
Rheumatic Patients

Abstract Background To compare the incidence and risk factors of serious infections among patients of seven common rheumatic diseases including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), polymyalgia rheumatica (PMR), Sjögren's syndrome (SS), systemic sclerosis (SSc), systemic vasculitis (VA), and other diffuse connective tissue diseases (oCTD). Methods In a retrospective cohort study using large Electronic Health Records (EHR) data, the infection rates of different rheumatic diseases in two years were calculated and variances on risk factors were analyzed using the multivariable Cox model. Results Among the overall 46,411 rheumatic patients, 8,308 presented serious hospitalized infections in the following two years (crude infection rates (IR) per 100 patient-years: 8.95, 8.76–9.14). SSc (10.89, 9.61–12.16), VA (10.82, 9.96–11.68), and SLE (10.13, 9.73–10.53) had relatively high IRs, while oCTD was with the lowest IR (7.71, 6.58–8.84). The Cox model identified previous infection (adjusted hazard ratio (HR):1.75, 1.62–1.88, p < 0.001), GCs usage (HR:1.64, 1.52–1.76, p < 0.001), nonbiologic DMARDs usage (HR:1.39, 1.32–1.45, p < 0.001) and congestive heart failure (CHF) (HR:1.42, 1.30–1.56, p < 0.001) as the top-ranked risk factors of infection in the overall population. While some of the variables were shared across subtypes of rheumatic diseases as highly associated risk factors, others varied significantly such as osteoporosis. Conclusions Infection rates and risk factors varied among cohorts of different rheumatic diseases. The analytical results may inform distinct strategies and influence clinical decision making to reduce the occurrence of infections.

Tu1788 CLINICAL CHARACTERISTICS AND TREATMENT DIFFERENCES BETWEEN YOUNGER AND OLDER ONSET MICROSCOPIC COLITIS: A MULTICENTER RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 158 (6) ◽  
pp. S-1161
Author(s):  
Amrit K. Kamboj ◽  
Amandeep Gujral ◽  
Elida Voth ◽  
Daniel Penrice ◽  
Jessica McGoldrick ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Microscopic Colitis
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