CJEM Articles: decision-making
Displaying 1-3 of 3 results
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May
2002
4
3
Andreas Laupacis, Brian Holroyd, Brian Rowe, Catherine M. Clement, Daniel Cass, Gary H. Greenberg, George A. Wells, Glen Bandiera, Howard Lesiuk, Iain MacPhail, Ian G. Stiell, James Worthington, Jonathan Dreyer, Laurie Morrison, Mark Reardon, Mary A. Eisenhauer, Michael Schull, R. Douglas McKnight, Richard Verbeek, Robert Brison
Clinical prediction rules are decision-making tools that incorporate three or more variables from the history, physical examination or simple tests. They help clinicians make diagnostic or therapeutic decisions by standardizing the collection and interpretation of clinical data. There is growing interest in the methodological standards for their development and validation. This article describes the methods used to derive the Canadian C-Spine Rule and provides a valuable reference for investigators planning to develop future clinical prediction rules.
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July
2001
3
3
Andrew Worster, Brian H. Rowe
The authors of studies often report their results using abbreviated terms such as RR, OR, ARR, RRR and NNT. These terms are quantities that express the strength of association between the dependent and independent variables and are collectively referred to as measures of association. The similarity between these measures and the multiple terms by which each is referred can be confusing. The purpose of this article is to explain in a straightforward manner the purpose, derivation, and limitations of some of the more commonly used categorical measures of association, including relative risk, odds ratio, absolute and relative risk reduction and number needed to treat, using results from recent emergency medicine studies published by Canadian researchers.
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April
2001
3
2
Cameron K. MacGougan, Grant D. Innes, James M. Christenson, Janet Raboud
Objectives: To determine Canadian emergency physicians' estimates regarding the safety and efficiency of chest discomfort management in their emergency department (ED), and their attitudes toward and perception of the need for a chest discomfort clinical prediction rule that identifies very low risk patients who are safe to discharge after a brief ED assessment.
Methods: 300 members of the Canadian Association of Emergency Physicians (CAEP) were randomly selected to receive a confidential mail survey, which invited them to provide information on current disposition of patients with chest discomfort and their opinions regarding the value of a clinical prediction rule to identify patients with chest discomfort who are safe to discharge after a brief (~2 hour) assessment.
Results: Of the 300 physicians selected, 288 were eligible for the survey and 235 (82%) responded. Only 5% follow discharged patients to measure safe practice. Overall, 165 (70%) felt the proposed prediction rule would be very useful and 43 (18%) felt it would be useful. Almost all (94%) believed a prediction rule would be useful if it identified patients safe for discharge without increasing the current rate of missed acute myocardial infarction (estimated at 2%). Most respondents (59%) believed that a clinical prediction rule should suggest a course of action, while 30% felt it should convey a probability of disease.
Conclusions: Canadian emergency physicians support the concept of a clinical prediction rule for the early discharge of patients with chest discomfort. Most believe that such a rule would be useful if it identified patients who are safe for discharge after a brief assessment, while maintaining current levels of safety. Future research should be aimed at deriving a clinical prediction rule to identify low risk patients who can be safely discharged after a limited emergency department evaluation.
