Clinical Prediction Rules in Practice
One way of implementing Evidence-Based Medicine for diagnosis and prognosis in clinical practice is to use appropriately validated and tested clinical prediction rules (CPRs). There are many that have been developed to aid diagnosis (and sometimes management) of a whole host of conditions. In this study we assessed whether CPRs were mentioned in guidelines and also whether General Practitioners were aware of them and used them. We did a systematic review of international clinical guidelines across different clinical areas, (including infection, cancer, cardiovascular disease, fracture, depression and stroke) and assessed whether they mentioned or recommended particular CPRs. We also did a survey of GPs from across the UK and asked them whether they knew of or used CPRs in these areas.
This study showed that of the clinical domains we studied, guidelines most commonly recommended CPRs for primary prevention of cardiovascular disease and most GPs used these in practice to assess cardiovascular risk, guide therapy and also to comply with guidelines. Depression was another condition where CPRs were commonly recommended and also used by most GPs. GPs frequently used a CPR, such as the Ottawa Ankle Rule, to assess fractures, although these were not recommended by most guidelines. However for other areas, such as cancer, although several guidelines recommended using a CPR, these were not used by GPs and most did not know about them. Our research shows that there are several factors influencing the use of CPRs and that overall there was a lack of familiarity with CPRs amongst GPs, they were uncertain about the evidence for these CPRs, and expressed a preference for their own clinical judgement. Future research should focus on providing well-validated CPRs in the areas in clinical practice where CPRs might be most beneficial to clinicians and patients.
Plüddemann A1, Wallace E, Bankhead C, Keogh C, Van der Windt D, Lasserson D, Galvin R, Moschetti I, Kearley K, O’Brien K, Sanders S, Mallett S, Malanda U, Thompson M, Fahey T, Stevens R. Clinical prediction rules in practice: review of clinical guidelines and survey of GPs. Br J Gen Pract. 2014 Apr;64(621):e233-42. doi: 10.3399/bjgp14X677860.
Clinical prediction rules: friend or foe?