Abstract
Introduction:
The Making Evidence Based Medicine Simple Series is an evidence-based clinical practice curriculum. It consists of six modules that review the articles types addressing the most common clinical questions (i.e., diagnosis, therapy, harm, prognosis, meta-analysis, and clinical decision rules). Each module reviews an article from the medical literature using the Users Guide to Medical Literature criteria for validity, results, and applicability. Each modules includes a PowerPoint presentation with a script, a video of the presentation with narration, a quiz with answers, tips for teaching the module, a blank review form, and a completed critical article review for the article reviewed in the module.
Methods:
The Clinical Decision Rule Module reviews the appraisal of the validity, results, and applicability of the derivation study of a pediatric head trauma clinical decision rule. The study addresses the following clinical question: In pediatric patients with blunt head trauma, do history and physical exam findings accurately identify patients at low risk for clinically important traumatic brain injury? In addition, this module reviews the following critical appraisal skills: (1) identifying the stages of development of a clinical decision rule, (2) calculating the rule characteristics from a recursive partitioning decision tree, (3) determining the impact of a clinical decision rule on resource utilization, and (4) understanding the applicability of a clinical decision rule based on its stage of development.
Results:
Evaluations by course participants have been extremely positive. Participants often comment that they have finally grasped important content that they have previously struggled with. The materials have been particularly useful to those who are leading a teaching session. Feedback from a 2013 course for pediatric emergency medicine fellows indicated that 92% of participants felt the Clinical Decision Rule Module was “extremely helpful.” In addition, 100% of participants agreed or strongly agreed that the modules improved their ability to appraise an article, and their ability to conduct evidence-based clinical practice. One-hundred percent also agreed or strongly agreed that the precourse materials were useful.
Discussion:
The Making Evidence Based Medicine Simple Series is a well-received evidence based clinical practice curriculum and the Clinical Decision Rule Module is an effective component of the series that can be used independently or with the other modules.
Educational Objectives
By the end of this session, learners will be able to:
Identify the study designs that address various diagnosis questions.
Define and understand the goals of a clinical decision rule.
Understand risk stratification as it applies to clinical decision rules.
Outline the population/patient, intervention/indicator, comparator/control, and outcome question for a clinical decision and compare to a diagnostic test study.
Understand the stages of development of a clinical decision rule.
Review the concept of multivariable statistics.
Interpret a decision tree resulting from recursive partitioning.
Understand the validity criteria for a clinical decision rule.
Define and calculate outcome prevalence from a decision tree and 2 × 2 table.
Define and calculate sensitivity and specificity from a decision tree and 2 × 2 table.
Define and calculate predictive values from a decision tree and 2×2 table.
Determine interpretation of confidence intervals for precision of rule characteristics.
Determine the impact of a clinical decision rule on resource utilization.
Understand the applicability of a clinical decision rule based on stage of development.
