I'm just pointing out their inherent flaws and biases. I'm not "railing against CDIs" and I'm not saying this one doesn't have value or that it wasn't well constructed. You picked it as an example in your post. When you read about missed diagnoses, M&Ms and review cases where EPs are getting sued, go back and calculate whether your favorite decision rule would have picked up on the diagnosis the EP missed. Name one decision rule that holds up in court as an actual gold standard for ruling out any disease.ĭo an experiment for yourself. They're interesting research tools but they don't cover your gluteus, in the real world, like a gold standard test does. But if you're using it to talk yourself out of ordering one, be careful. In other words, if you want to use a decision rule to talk yourself into ordering a test, fine. I've found that if after your initial evaluation, you haven't immediately dismissed the need for a study out of hand, and you're worried enough to actually see the time to go through the motions of using some decision rule to make your decision for you, then you probably ought to be ordering the test to actually rule out what you're considering and not relying on some decision rule developed in EBM-Utopia World to talk you out of ordering a test your gut is apparently telling you you're worried enough to probably need. They're interesting tools, but they don't replace your brain. As long as you're okay with missing 1-2 MI/PE/c-spine fractures out of every 100 angina/SOB/neck-injury patients you see. Then people react like this, "Wow, that's amazing. They they'll conclude, "98.5% sensitive, only 1.5 (_insert above never-miss diagnosis_) out of 100 _s were missed." They'll be looking at something like PE, cervical spine injury or MI. These rules will come and go over the years. ![]() You're patient may not fit within the box they drew for their study.Īlso, some of them make me laugh, really really laugh. That's probably the most important thing to know about these rules and something most people cranking away computing these scores never even stops to think about.ĭid they exclude patients above/below a certain age?ĭid they exclude patients who were too sick/not sick enough?ĭid they exclude admitted patients or discharged patients?ĭid they exclude/exclude intoxicated patients? They're made and developed in a perfect "research ED world." Any one of your patients may or may not have even been included in any given study used to formulate a specific decision rule. You should learn them and get to a point you're using them intuitively without necessarily computing scores on people constantly.Īlthough these decision rules can be helpful and you should know them, be aware they usually use strict inclusion and exclusion criteria.
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