Episode 56 The Stiell Sessions: Clinical Decision Rules and Risk Scales

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 30 December 2014

⏱️ 59 minutes

🔗️ Recording | iTunes | RSS

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Summary

There are hundreds of clinical decision rules and risk scales published in the medical literature, some more widely adopted than others. Ian Stiell, the father of clinical decision rules, shares with us his views and experiences gained from co-creating some of the most influential CDRs and risk scales to date. He explains the criteria for developing a CDR, the steps to developing a valid CDR, how best to apply CDRs and risk scales to clinical practice, and the hot-off the-press new Ottawa COPD Risk Score and Ottawa Heart Failure Risk Score for helping you with disposition decisions. It turns out that in Canada, we discharge about two thirds of the acute decompensated heart failure patients that we see in the ED, while the US almost all patients with decompensated heart failure are admitted to hospital. Dr. Stiell's new risk scores may help physicians in Canada make safer disposition decisions while help physicians in the US avoid unnecessary admissions.

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast.
0:05.8	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine
0:10.5	from EMC Studios in Toronto.
0:14.4	This is just a piece of the puzzle, so we're giving you information you never had before.
0:19.5	Let's talk about the relationship between Gestalt and clinical decision rules.
0:24.8	Our goal and our responsibility is to make sure these tools are as good as or better
0:30.9	than the judgment of a seasoned clinician.
0:36.4	We want to do what's in the best interest of the patient and not the doctor or his
0:41.4	insurance company.
0:43.2	Use these rules appropriately.
0:45.3	Know the inclusion exclusion criteria.
0:48.2	So for those kind of scales, we're not advocating there's a threshold at which you must do this or that.
0:55.5	Ian is rolling his eyes.
0:58.1	They can't see it, but they'll probably feel it over the airwaves.
1:19.2	CDRs are insanely popular among researchers. The number of papers discussing prediction rules more than doubled between 1995 and 2005 to a whopping 15,662 papers, and I'm guessing may have doubled since then.
1:30.6	This huge body of CDR literature can be overwhelming for the EM provider.
1:35.7	It seems that there's a clinical decision rule with a nifty mnemonic for just about everything.
1:40.9	Curb 65, Chads 2, ISS, Nexus, P-Carn, the list goes on and on and on.
1:47.0	Now some CDRs have been shown to be more accurate than physician judgment alone, while others have not.
1:54.0	Some are rigorously developed and validated, and others aren't.
1:58.0	Some are so complicated that no EM practitioner could be expected to remember them,
2:02.6	while others are simple and easily memorized.
	...

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