Practice Management Book


Clinical Decision Rule

Aka: Clinical Decision Rule, Decision Support Techniques, Clinical Prediction Rule, Decision Aids
  1. 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
  2. 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
  3. Examples
    1. Head and Neck
      1. Canadian CT Head Rule
      2. New Orleans Head CT Rule
      3. Canadian Cervical Spine Rule
      4. NEXUS Cervical Spine Decision Rule
      5. Sinusitis Prediction Rule
      6. Strep Score
    2. Thoracic
      1. See Chest Pain Decision Rules
      2. Bosner Chest Pain Decision Rule
      3. Diamond and Forrester Chest Pain Prediction Rule
      4. Vancouver Chest Pain Rule
      5. Dual-Antiplatelet Therapy Decision Rule
      6. Chest Wall Pain Prediction Rule
      7. CHF Decision Rule for Predicting Mortality
      8. Diehr Rule to Diagnose Pneumonia
      9. Nexus Chest CT Decision Rule in Blunt Trauma
      10. San Francisco Syncope Rule
    3. Abdomen
      1. Blunt Abdominal Trauma Decision Rule for Children
    4. Hematology and Oncology
      1. Neutropenic Fever Clinical Decision Rule
      2. Wells Clinical Prediction Rule for DVT
      3. Wells Clinical Prediction Rule for PE
      4. PERC Rule (Pulmonary Embolism Rule-Out Criteria)
    5. Neurologic
      1. Oostenbrink Clinical Decision Rule for Meningitis
      2. Nigrovic Clinical Decision Rule (Meningitis)
    6. Musculoskeletal
      1. Ottawa Ankle Rule
      2. Ottawa Knee Rule
      3. Pittsburgh Knee Rules
      4. Rheumatoid Arthritis Prediction Rule for Undifferentiated Arthritis
    7. Miscellaneous
      1. TEN-4 Rule (Child Abuse)
  4. References
    1. Mason, Grock, Carmelli in Herbert (2018) 18(6): EM:Rap 12-3

Decision Support Techniques (C0011113)

Definition (MSH) Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.
Concepts Intellectual Product (T170)
MSH D003661
English Decision Support Technic, Decision Support Technics, Decision Support Technique, Decision Support Techniques, Technic, Decision Support, Technics, Decision Support, Technique, Decision Support, Techniques, Decision Support
Swedish Beslutsstödstekniker
Finnish Päätöksentukimenetelmät
Japanese 意思決定支援技法, ディシジョンモデリング, モデル-意思決定支援, 意思決定支援モデル, 意思決定分析, 決定分析
French Techniques d'aide à la décision, Technologie d'aide à la prise de décision, Technologie d'aide à la décision, Techniques d'aide à la prise de décision
Italian Tecnica di supporto decisionale, Tecniche di supporto decisionale
Polish Modelowanie decyzyjne, Metody wsparcia decyzji, Metody wspomagania decyzji, Analiza decyzyjna
Czech rozhodování - techniky pomocné, metody pro podporu rozhodování, metody na podporu rozhodování
Norwegian Beslutningsstøtteteknikker
Spanish Técnicas de Apoyo a la Toma de Decisiones, Técnicas de Apoyo para la Decisión
Portuguese Técnicas de Apoio à Decisão, Modelos de Apoio à Decisão, Técnicas de Apoio para a Decisão
German Entscheidungsunterstützende Techniken
Dutch Beslissingsondersteunende techniek, Beslissingsondersteunende technieken
Derived from the NIH UMLS (Unified Medical Language System)

Decision Aids (C0086104)

Concepts Intellectual Product (T170)
MSH D003661
English Aid, Decision, Aids, Decision, Decision Aid, decision aids, decision aid, Decision Aids
French Supports à la décision, Aides à la décision
Italian Presa di decisione
Norwegian Beslutningshjelpemidler
Derived from the NIH UMLS (Unified Medical Language System)

Clinical Prediction Rule (C3179496)

Definition (MSH) Use of a combination of multiple tests, both with positive and negative results, to arrive at a course of action.
Concepts Intellectual Product (T170)
MSH D003661
English Prediction Rule, Clinical, Clinical Prediction Rule, Prediction Rules, Clinical, Rule, Clinical Prediction, Rules, Clinical Prediction, Clinical Prediction Rules
Italian Regola di predizione clinica
Norwegian Klinisk prediksjonsregel
Derived from the NIH UMLS (Unified Medical Language System)

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