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.

Deferral of the Rectal Examination in Blunt Trauma Patients: A Clinical Decision Rule

2004 ◽  
Vol 11 (5) ◽  
pp. 635-641 ◽  
Author(s):  
Gregory Guldner ◽  
Jonathan Babbitt ◽  
Mike Boulton ◽  
Thomas O' Callaghan ◽  
Rehema Feleke ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Decision Rule ◽  
Clinical Decision ◽  
Trauma Patients ◽  
Clinical Decision Rule ◽  
Rectal Examination

A Clinical Decision Rule for Thoracolumbar Spine Imaging in Blunt Trauma?

2016 ◽  
Vol 68 (6) ◽  
pp. 781-783 ◽  
Author(s):  
Jeff Riddell ◽  
Kenji Inaba ◽  
Paul Jhun ◽  
Mel Herbert
Keyword(s):  
Blunt Trauma ◽  
Decision Rule ◽  
Thoracolumbar Spine ◽  
Clinical Decision ◽  
Clinical Decision Rule ◽  
Spine Imaging

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 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

Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma

2015 ◽  
Vol 78 (3) ◽  
pp. 459-467 ◽  
Author(s):  
Kenji Inaba ◽  
Lauren Nosanov ◽  
Jay Menaker ◽  
Patrick Bosarge ◽  
Lashonda Williams ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Decision Rule ◽  
Thoracolumbar Spine ◽  
Clinical Decision ◽  
Clinical Decision Rule

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.

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