References
UK Survey of emergency physicians’ priorities for clinical decision rules
Abstract
One of the first stages in the development of new clinical decision rules (CDRs) is determination of perceived need because this is the most important predictor of ultimate adoption. This study examined the current use of two common CDRs and the clinical priorities of UK emergency physicians (EPs) for the development of future CDRs. Methods: The authors administered an e-mail and postal survey to a random sample of 350 members of the British Association of Emergency Medicine (total membership n=1700). Results: The total response rate was 44.5% (155/350). The respondents were predominantly male (67.7%), with a mean age of 44.0 years (SD +/- 10), and a mean of 10.8 years experience (SD +/- 7). Regarding the two pre-existing Canadian C-spine and CT head rules, 62% of responders were aware of these rules. Regarding a proposed acute headache CDR, 94.6% of those surveyed indicated that they would consider using a highly sensitive and well-validated decision rule if it was developed. The top priorities in the four main categories were admission with anterior chest pain (42.8%), imaging for suspected transient ischaemic attack (34.5%), management of serious vertigo (29.7%) and investigation of febrile child <36 months (40.6%), respectively. Discussion: This UK survey identified the sampled emergency physicians’ priorities for the future development of CDRs. The top priority was investigation of the febrile child < 36 months. These results will be valuable to researchers for future development of CDRs in emergency medicine in the UK.
Clinical decision rules (CDRs) are decision-making tools designed and validated by research that use variables from the history, examination, and other test results to help clinicians make decisions about admission, diagnosis, or treatment (Stiell and Bennett, 2008). They are particularly useful in the time-pressured environments of emergency departments. CDRs are produced in three phases, derived by a process of systematic research, validated via prospective trials, and assessed once implemented for impact (McGinn et al, 2000; Stiell and Bennett, 2008).
Clinical decision rules have become common place in emergency departments for helping clinicians standardize care, improve patient flow and assist in diagnoses (Wasson et al, 1985; Stiell, 2000). They are most commonly used for clinical problems with a vague clinical presentation, and with life-threatening consequences, such as pulmonary embolus or cervical spine injury.
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