scholarly journals Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting

2017 ◽  
Vol 22 (10) ◽  
pp. 1283-1292 ◽  
Author(s):  
Lely Solari ◽  
Alonso Soto ◽  
Patrick Van der Stuyft
2005 ◽  
Vol 29 (1) ◽  
pp. 21-23 ◽  
Author(s):  
Sian Fielding

Aims and MethodTo assess the value of computed tomography (CT) in patients presenting to an old age psychiatry service over a 2-year period, and to evaluate a set of clinical prediction rules and the recommendations of the Royal College of Psychiatrists on the selection of patients for scanning. A retrospective review of the reports of 178 consecutive scans and case note reviews was carried out.ResultsFour scan reports (2.3%) suggested potentially reversible causes (PRCs) of dementia. of these, only two showed unequivocal organic brain lesions. Both of these patients were identified by each of the prediction rules tested. There was a high incidence of small vessel disease (32.8%) and infarcts (11.9%).Clinical ImplicationsCT is a low-yield investigation in terms of identifying patients with PRCs of dementia. The tested clinical prediction rules appear sensitive in detection of PRCs. CT may demonstrate unsuspected cerebrovascular disease.


PEDIATRICS ◽  
2009 ◽  
Vol 124 (1) ◽  
pp. e145-e154 ◽  
Author(s):  
J. L. Maguire ◽  
K. Boutis ◽  
E. M. Uleryk ◽  
A. Laupacis ◽  
P. C. Parkin

2019 ◽  
Vol 20 (3) ◽  
pp. 281-285
Author(s):  
Dragan Panic ◽  
Andreja Todorovic ◽  
Milica Stanojevic ◽  
Violeta Iric Cupic

Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.


2007 ◽  
Vol 98 (11) ◽  
pp. 980-987 ◽  
Author(s):  
Karen Dahri ◽  
Peter Loewen

SummaryIt was the objective of this article to qualitatively review and evaluate the clinical prediction rules (CPRs) available for estimating bleeding risk in patients commencing warfarin therapy. A systematic review of PubMed (1949 to December 2006), MEDLINE (1966 to December 2006); EMBASE (1980 to December 2006), Cochrane Database of Systematic Reviews (to December 2006), and International Pharmaceutical Abstracts (1970 to Demember 2006) was conducted. Seven studies were found that detailed CPRs used to assess risk of bleeding prior to commencing warfarin therapy. Four studies described distinct CPRs. The remaining three studies were further validations of one of the CPRs, the Outpatient Bleeding Risk Index. The Outpatient Bleeding Risk Index was classified as being of Level 2 evidence while the remaining three indices were classified as being of Level 4 evidence. In no case did the CPRs exhibit performance characteristics that would indicate“strong” ability to predict the presence of absence of major bleeding among warfarin recipients. The modified Outpatient Bleeding Risk Index exhibited moderate predictive ability for major bleeding in two studies, although pooling of all studies of this CPR did not reveal moderate or better performance. None of the CPRs identified “any bleeding” with moderate or strong predictive ability. None of the available CPRs exhibit sufficient predictive accuracy or have trials evaluating the impact of their use on patient outcomes. Hence, no existing CPR can be recommended for widespread use in practice at present.


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