Division of Population Health Sciences Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Developing a web-based international register of clinical prediction rules (CPRs) for primary care Claire Keogh, PhD; Susan Smith, MD; Emma Wallace, MD; Rose Galvin, PhD; Kirsty O'Brien, PhD; Tom Fahey, MD HRB Centre for Primary Care Research

Division of Population Health Sciences Overview Definitions and the need for an international register of CPRs for primary care Search strategies to identify CPRs relevant to primary care from the MEDLINE database The International Register of CPRs for Primary Care –Clinical domains –Ongoing work

Division of Population Health Sciences Clinical Prediction Rules Clinical tools that quantify the contribution of Patient History Physical Examination Diagnostic Tests Stratify patients diagnosis Probability of having a target disorder Outcome can be in terms of diagnosis, prognosis, referral or treatment

Example of a CPR: The Centor Score

Division of Population Health Sciences Stages of development of CPR

Purpose Develop a web-based register of CPRs for use in primary care

Division of Population Health Sciences Problems with developing and maintaining the register Problems associated with developing and maintaining the register –Interchangeable terminology for CPRs –No Medical Subject Heading (MeSH) term for CPRs –Over two million articles are published every year

Problems with developing and maintaining the register Haynes and the Hedges Team have developed search tools to identify CPRs.

Division of Population Health Sciences Developing a search string for MEDLINE using the PubMed interface

MEDLINE versus the final search filter applied to 30 primary care journals ( 1966 – 2008 ) Number of articles in PubMEd Year of publication

Primary source PubMed Expert contact Personal databases Published Unpublished Secondary sources Rational Clinical Examination (JAMA) Evidence-based diagnosis (Ebell) Register Information sources

The register Currently comprises of 559 articles

Number of articles in each clinical domain (ICPC 2 )

Number of articles for respiratory conditions (ICPC 2 )

Levels of evidence

Quality assessment for derivation articles

Quality assessment for validation articles

Division of Population Health Sciences

Summary Identified the search filter with the highest level of sensitivity to search the MEDLINE database (PubMed) 559 CPRs across several clinical domains Ongoing work: Identifying and classifying all derivation articles for article where only the validation was retrieved End result will be a web-based database for clinicians and researchers