Systematic review of the effects of care provided with and without diagnostic clinical prediction rules

Sanders, Sharon L.; Rathbone, John; Bell, Katy J. L.; Glasziou, Paul P.; Doust, Jenny A.

doi:10.1186/s41512-017-0013-2

Diagnostic and Prognostic Research

Table 1 Characteristics of the included studies by clinical condition

From: Systematic review of the effects of care provided with and without diagnostic clinical prediction rules

Study/location/setting	Diagnostic strategies tested		Proposed role of the CPR or experimental diagnostic strategy	Use of the CPR or experimental diagnostic strategy	Application of the output of the CPR or experimental diagnostic strategy	Primary outcome of the study^a
Study/location/setting	Study arm	Interventions (output format of the CPR or diagnostic strategy)		Use of the CPR or experimental diagnostic strategy		Primary outcome of the study^a
Group A Streptococcus infection of the throat
Worrall et al. 2007 [19]/Canada/PC	Experimental	Clinicians’ usual practice + Centor Score (D)	Add-on	Expected	Discretionary	Clinical decision
	Experimental	Clinicians’ usual practice + Centor Score + RADT (D)
	Control	Clinicians’ usual practice
McIsaac and Goel 1998 [33]/Canada/PC	Experimental	Clinician + Centor Score (D)	Replacement	Expected	Discretionary	Clinical decision
McIsaac and Goel 1998 [33]/Canada/PC	Control	Clinician + structured clinical checklist	Replacement	Expected	Discretionary	Clinical decision
McIsaac et al. 2002 [34]/Canada/PC	Experimental	Clinician + modified Centor Score (D)	Replacement	Expected	Discretionary	Clinical decision
McIsaac et al. 2002 [34]/Canada/PC	Control	Clinician + structured clinical checklist	Replacement	Expected	Discretionary	Clinical decision
McGinn et al. 2013 [32]/USA/PC^b	Experimental	Clinicians’ usual care + Walsh Rule (D)	Add-on	Discretionary	Discretionary	Clinical decision
McGinn et al. 2013 [32]/USA/PC^b	Control	Clinicians’ usual care^c	Add-on	Discretionary	Discretionary	Clinical decision
Little et al. 2013 [18]/UK/PC	Experimental	Clinician + FeverPAIN score (D)	Replacement	Expected	Discretionary	Patient outcome
	Experimental	Clinician + FeverPAIN score + RADT (D)
	Control	Clinician + strategy of delayed antibiotics
Acute appendicitis
Douglas et al. 2000 [25]/Australia/SU	Experimental	Clinicians’ clinical diagnosis + Alvarado score + US (D)	Add-on	Expected	Discretionary^d	Process of care
Douglas et al. 2000 [25]/Australia/SU	Control	Clinicians’ clinical diagnosis^c	Add-on	Expected	Discretionary^d	Process of care
Farahnak et al. 2007 [27]/Iran/ED	Experimental	Clinicians’ assessment + Alvarado score (D)	Add-on	Expected	Discretionary	Process of care
Farahnak et al. 2007 [27]/Iran/ED	Control	Clinicians’ assessment	Add-on	Expected	Discretionary	Process of care
Lintula et al. 2010 [31]/Finland/ED	Experimental	Clinicians’ assessment + Lintula score (D)	Add-on	Expected	Discretionary	Accuracy
Lintula et al. 2010 [31]/Finland/ED	Control	Clinicians’ assessment^c	Add-on	Expected	Discretionary	Accuracy
Lintula et al. 2009 [30]/Finland/ED	Experimental	Clinicians’ assessment + Lintula score (D)	Add-on	Expected	Discretionary	Accuracy
Lintula et al. 2009 [30]/Finland/ED	Control	Clinicians’ assessment^c	Add-on	Expected	Discretionary	Accuracy
Wellwood et al. 1992 [20]/UK/ED	Experimental	Clinicians’ assessment + Leeds decision support system (A)	Add-on/replacement	Expected	NA	Accuracy
	Control	Clinician with no diagnostic aid
	Control	Clinician + structured data collection form
Serious bacterial infection in children with fever
Roukema et al. 2008 [36]/The Netherlands/ED	Experimental	Clinicians’ assessment + prediction rules of Bleeker^e (D)	Add-on	Expected	Discretionary	Process of care
Roukema et al. 2008 [36]/The Netherlands/ED	Control	Clinicians’ assessment	Add-on	Expected	Discretionary	Process of care
Lacroix et al. 2014 [44]/Switzerland/ED	Experimental	Clinician + LAB score (procalcitonin, CRP, urinary dipstick) (D) blind to WBC count and differential	Replacement	Expected	Discretionary	Clinical decision
Lacroix et al. 2014 [44]/Switzerland/ED	Control	Clinician + WBC count, band count and CRP, blind to procalcitonin and LAB score	Replacement	Expected	Discretionary	Clinical decision
de Vos-Kerkhof et al. 2015 [43]/The Netherlands/ED	Experimental	Clinicians’ usual care + Rule of Nijman (D)	Add-on	Expected	Discretionary	Clinical decision
de Vos-Kerkhof et al. 2015 [43]/The Netherlands/ED	Control	Clinicians’ usual care	Add-on	Expected	Discretionary	Clinical decision
Acute coronary syndrome
Than et al. 2014 [40]/New Zealand/ED	Experimental	Accelerated diagnostic pathway: TIMI score, ECG + troponin at presentation and 2 h after symptom onset (D)	Replacement	Expected	Discretionary	Clinical decision
Than et al. 2014 [40]/New Zealand/ED	Control	Standard-care chest pain pathway: initial ECG + troponin at presentation and 6–12 h after symptom onset	Replacement	Expected	Discretionary	Clinical decision
Sanchis et al. 2010 [37]/Spain/ED	Experimental	Sanchis risk score + NT-proBNP (D)	Replacement	Expected	Discretionary	Process of care
Sanchis et al. 2010 [37]/Spain/ED	Control	Chest pain unit protocol with early exercise testing	Replacement	Expected	Discretionary	Process of care
Mahler et al. 2015 [46]/USA/ED	Experimental	HEART Pathway: HEART score (including ECG) + troponin at presentation and 3 h later (D)	Replacement	Expected	Discretionary	Clinical decision
Mahler et al. 2015 [46]/USA/ED	Control	Clinicians’ encouraged to follow current guidelines	Replacement	Expected	Discretionary	Clinical decision
Bacterial pneumonia
Ferrero et al. 2015 [45]/Argentina/OC	Experimental	Bacterial pneumonia score (D)	Replacement	Expected	Mandatory	Clinical decision
Ferrero et al. 2015 [45]/Argentina/OC	Control	Standard management based on institutional guidelines	Replacement	Expected	Mandatory	Clinical decision
Torres et al. 2014 [41]/Argentina/OC	Experimental	Bacterial pneumonia score (D)	Replacement	Expected	Mandatory	Clinical decision
Torres et al. 2014 [41]/Argentina/OC	Control	Standard management based on institutional guidelines	Replacement	Expected	Mandatory	Clinical decision
McGinn et al. 2013 [32]/USA/ED^b	Experimental	Clinicians’ usual care + Walsh Rule (D)	Add-on	Discretionary	Discretionary	Clinical decision
McGinn et al. 2013 [32]/USA/ED^b	Control	Clinicians’ usual care^c	Add-on	Discretionary	Discretionary	Clinical decision
Ankle/foot fracture
Auleley et al. 1997 [23]/France/ED	Experimental	Clinicians’ usual practice + Ottawa Ankle Rules (D)	Add-on	Discretionary	Discretionary	Clinical decision
Auleley et al. 1997 [23]/France/ED	Control	Clinicians’ usual practice^c	Add-on	Discretionary	Discretionary	Clinical decision
Fan et al. 2006 [26]/Canada/ED	Experimental	Ottawa Ankle Rules (D): if positive x-ray, if negative clinical assessment	Triage	Expected	Mandatory	Process of care
Fan et al. 2006 [26]/Canada/ED	Control	Standard departmental care	Triage	Expected	Mandatory	Process of care
Joint or bone injuries of the extremities in children
Klassen et al. 1993 [29]/Canada/ED	Experimental	Brand protocol (D): if positive x-ray, if negative clinical assessment	Triage	Expected	Mandatory	Clinical decision
Klassen et al. 1993 [29]/Canada/ED	Control	Standard care	Triage	Expected	Mandatory	Clinical decision
Suspicious pigmented skin lesion
Walter et al. 2012 [42]/UK/PC	Experimental	Best practice: history, naked eye examination, seven-point checklist + primary care scoring algorithm + SIAscopy scanner (A)	Add-on	Expected	Discretionary	Clinical decision
Walter et al. 2012 [42]/UK/PC	Control	Best practice: history, naked eye examination, seven-point checklist	Add-on	Expected	Discretionary	Clinical decision
Pulmonary embolism
Rodger et al. 2006 [35]/Canada/NMD	Experimental	Bedside tests (D): Wells’ PE score, D-dimer, AVDSf—if ≥2 tests positive VQ scan	Triage	Expected	Mandatory	Patient outcome
Rodger et al. 2006 [35]/Canada/NMD	Control	Initial VQ scan blind to bedside tests	Triage	Expected	Mandatory	Patient outcome
Gastro-oesophageal reflux disease
Horowitz et al. 2007 [28]/Israel/PC	Experimental	Algorithm (D): alarm symptom assessment—if positive gastroscopy conducted, if negative GERD score used. If GERD score positive treat, if negative C-urea breath test	Replacement	Expected	Mandatory	Patient outcome
Horowitz et al. 2007 [28]/Israel/PC	Control	Doctors’ discretion	Replacement	Expected	Mandatory	Patient outcome
Acute small bowel obstruction
Bogusevicius et al. 2002 [24]/Lithuania/SU	Experimental	Rule of Bogusevicius (D)	Replacement	Expected	Mandatory	Accuracy
Bogusevicius et al. 2002 [24]/Lithuania/SU	Control	Contrast radiography	Replacement	Expected	Mandatory	Accuracy
Clinically important brain injury
Stiell et al. 2010 [39]/Canada/ED	Experimental	Clinicians’ usual practice + Canadian CT Head Rule (D)	Add-on	Expected	Discretionary	Clinical decision
Stiell et al. 2010 [39]/Canada/ED	Control	Clinicians’ usual practice	Add-on	Expected	Discretionary	Clinical decision
Cervical spine fracture
Stiell et al. 2009 [38]/Canada/ED	Experimental	Clinicians’ usual practice + Canadian C-Spine Rule (D)	Add-on	Expected	Discretionary	Clinical decision
Stiell et al. 2009 [38]/Canada/ED	Control	Clinicians’ usual practice	Add-on	Expected	Discretionary	Clinical decision

CPR clinical prediction rule, (D) directive output format, i.e. suggests a course of action, (A) assistive output format, i.e. provides a probability without suggesting a course of action, RADT rapid antigen detection test, US ultrasound, CRP C-reactive protein, AVDSf alveolar dead-space fraction, VQ ventilation-perfusion scan, PC primary care, SU surgical unit, ED emergency department, OC outpatient clinic, NMD nuclear medicine department
^aThe outcome stated by the study as being the primary outcome or the outcome for which a power calculation was conducted. In the absence of these, the primary outcome was considered to be the outcome mentioned in the study objective or reported first in the results section. Patient outcomes are direct measures of patients health, e.g. symptoms, clinical events. Process of care outcomes are measures of the healthcare provided, e.g. length of stay, time to operation
^bThis study evaluated CPRs for two different clinical conditions
^cThe diagnostic strategy may be modified by the provision of information related to the CPRs being tested
^dApplication mandatory only for certain patients
^eDifferent rules for self-referred and clinician-referred patients

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