Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis

Diagnostic error is a major threat to patient safety in the context of the primary care setting. Evidence-based medicine has been advocated as one part of a solution. The ability to effectively apply evidence-based medicine implies the use of information systems by providing efficient access to the latest peer-reviewed evidence-based information sources. A fundamental challenge in applying information technology to a diagnostic clinical domain is how to formally represent known clinical knowledge as part of an underlying evidence repository. Clinical prediction rules (CPRs) can provide the basis for a formal representation of knowledge. The TRANSFoRm project defines the architectural components required to deliver a solution by providing an ontology driven clinical evidence service to support provision of diagnostic tools, designed to be maintained and updated from electronic sources of research data, to assist primary care clinicians during the patient consultation through delivery of up to date evidence based diagnostic rules.

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The Effect of Amoxicillin in Adult Patients Presenting to Primary Care with Acute Cough Predicted to Have Pneumonia or a Combined Viral-Bacterial Infection

Antibiotics ◽

10.3390/antibiotics10070817 ◽

2021 ◽

Vol 10 (7) ◽

pp. 817

Author(s):

Robin Bruyndonckx ◽

Beth Stuart ◽

Paul Little ◽

Niel Hens ◽

Margareta Ieven ◽

...

Keyword(s):

Primary Care ◽

Bacterial Infection ◽

Controlled Trial ◽

Symptom Duration ◽

Antibiotic Prescribing ◽

Clinical Prediction ◽

Acute Cough ◽

Clinical Prediction Rules ◽

Prediction Rules ◽

Combined Infection

While most cases of acute cough are self-limiting, antibiotics are prescribed to over 50%. This proportion is inappropriately high given that benefit from treatment with amoxicillin could only be demonstrated in adults with pneumonia (based on chest radiograph) or combined viral–bacterial infection (based on modern microbiological methodology). As routine use of chest radiographs and microbiological testing is costly, clinical prediction rules could be used to identify these patient subsets. In this secondary analysis of data from a multicentre randomised controlled trial in adults presenting to primary care with acute cough, we used prediction rules for pneumonia or combined infection and assessed the effect of amoxicillin in patients predicted to have pneumonia or combined infection on symptom duration, symptom severity and illness deterioration. In total, 2056 patients that fulfilled all inclusion criteria were randomised, 1035 to amoxicillin, 1021 to placebo. Neither patients with a predicted pneumonia nor patients with a predicted combined infection were significantly more likely to benefit from amoxicillin. While the studied clinical prediction rules may help primary care clinicians to reduce antibiotic prescribing for low-risk patients, they did not identify adult acute cough patients that would benefit from amoxicillin treatment.

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A Systematic Review of Clinical Prediction Rules to Predict Hospitalisation in Children with Lower Respiratory Infection in Primary Care and their Validation in a New Cohort

EClinicalMedicine ◽

10.1016/j.eclinm.2021.101164 ◽

2021 ◽

Vol 41 ◽

pp. 101164

Author(s):

Dermot M Wildes ◽

Master Chisale ◽

Richard J Drew ◽

Peter Harrington ◽

Chris J Watson ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Respiratory Infection ◽

Lower Respiratory Infection ◽

Clinical Prediction ◽

Clinical Prediction Rules ◽

Prediction Rules

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Utility of Electronic International Register of Clinical Prediction Rules Relevant to Primary Care

2016 IEEE 29th International Symposium on Computer-Based Medical Systems (CBMS) ◽

10.1109/cbms.2016.26 ◽

2016 ◽

Cited By ~ 2

Author(s):

Atieh Zarabzadeh ◽

Ronan McDonnell ◽

Stefan Paz Berrios ◽

John Dempsey ◽

Emma Harrington ◽

...

Keyword(s):

Primary Care ◽

Clinical Prediction ◽

Clinical Prediction Rules ◽

Prediction Rules

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Clinical prediction rules combining signs, symptoms and epidemiological context to distinguish influenza from influenza-like illnesses in primary care: a cross sectional study

BMC Family Practice ◽

10.1186/1471-2296-12-4 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 30

Author(s):

Barbara Michiels ◽

Isabelle Thomas ◽

Paul Van Royen ◽

Samuel Coenen

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Clinical Prediction ◽

Sectional Study ◽

Clinical Prediction Rules ◽

Cross Sectional ◽

Prediction Rules

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Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study

BMJ Open ◽

10.1136/bmjopen-2020-039913 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039913

Author(s):

Rosanne van Maanen ◽

Annelieke E C Kingma ◽

Ruud Oudega ◽

Frans H Rutten ◽

Karel Moons ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Venous Thromboembolism ◽

Failure Rate ◽

Real Life ◽

Clinical Prediction ◽

Clinical Prediction Rules ◽

Cross Sectional ◽

Prediction Rules ◽

Life Impact

ObjectiveClinical prediction rules (CPRs) followed by D-dimer testing were shown to safely rule out venous thromboembolism (VTE) in about half of all suspected patients in controlled and experienced study settings. Yet, its real-life impact in primary care is unknown. The aim of this study was to determine the real-life impact of CPRs for suspected VTE in primary care.DesignCross-sectional cohort study.SettingPrimary care in the Netherlands.ParticipantsPatients with suspected deep venous thrombosis (n=993) and suspected pulmonary embolism (n=484).InterventionsGeneral practitioners received an educational instruction on how to use CPRs in suspected VTE. We did not rectify incorrect application of the CPR in order to mimic daily clinical care.Main outcome measuresPrimary outcomes were the diagnostic failure rate, defined as the 3-month incidence of VTE in the non-referred group, and the efficiency, defined as the proportion of non-referred patients in the total study population. Secondary outcomes were determinants for and consequences of incorrect application of the CPRs.ResultsIn 267 of the included 1477 patients, VTE was confirmed. When CPRs were correctly applied, the failure rate was 1.51% (95% CI 0.77 to 2.86), and the efficiency was 58.1% (95% CI 55.2 to 61.0). However, the CPRs were incorrectly applied in 339 patients, which resulted in an increased failure rate of 3.31% (95% CI 1.07 to 8.76) and a decreased efficiency of 35.7% (95% CI 30.6 to 41.1). The presence of concurrent heart failure increased the likelihood of incorrect application (adjusted OR 3.26; 95% CI 1.47 to 7.21).ConclusionsCorrect application of CPRs for VTE in primary care is associated with an acceptable low failure rate at a high efficiency. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a higher failure rate and a considerably lower efficiency.

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