II. Indications

  1. Risk stratification for the evaluation and management of presentations with risk of poor outcome
  2. Limit testing that would otherwise risk adverse effects (e.g. radiation exposure)
  3. Standardize the approach to common conditions (esp. for those with less experience)
  4. Checklist documentation to prevent errors

III. Precautions: Pitfalls

  1. Clinical Decision Rules may be misapplied
  2. Use decision rules that have been prospectively validated, refined and used in clinical practice
  3. Decision rules should have high Test Sensitivity
    1. However, this is at the expense of Test Specificity with a high rate of False Positive tests
    2. Use clinical gestalt when interpreting the results of Clinical Decision Rules
  4. Many decision rules have a subjective component (e.g. Wells Score "PE more likely than alternatives")
  5. Avoid applying the decision tool to patients outside the population studied
    1. Be aware of the study inclusion and exclusion criteria
  6. Avoid mashing multiple decision tools together
    1. Use each decision tool individually, in the way it was validated
    2. Be cautious when applying 2 decision rules, each directing a different approach

V. References

  1. Mason, Grock, Carmelli in Herbert (2018) 18(6): EM:Rap 12-3

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