Department of Primary Health Care University of Oxford Matthew Thompson Co-Director, MaDOx International Clinical Prediction Rules Meeting: Dublin

Monitoring Diagnosis Oxford Centre for Monitoring & Diagnosis (MaDOx) Horizon scanning for new technologies Developing clinical decision rules Field studies Self-monitoring IPD Methods for screening intervals BP, lipids, INR, glucose, IOP

Clinical Decision Rules ‘Attempt to test, simplify, & increase accuracy of clinicians’ diagnostic and prognostic assessments’ McGinn, JAMA, 2000

Taxonomy … Age (months) Heart rate (bpm) Temperature (Celsius) Xin Liu, M.Sc. dissertation, University of Oxford 2009 What is a normal heart rate in a child with a fever? APLS cut off Thompson, Perera, Arch Dis Child 2009

Taxonomy … In patients with HIV, when to safely schedule the next CD4 test? Buclin, Perera et al. Buclin et al., University of Oxford 2009

Taxonomy … Simple, formal rules Diagnostic scores Screening scores Severity scores Prognostic scores Risk predictors Life expectancy projections Multi-endpoint prediction models … Multi-part diagnostic criteria(e.g. metabolic syndrome) Diagnostic tests Informal rules

Taxonomy … Simple, formal rules (e.g. Ottawa ankle fracture) Diagnostic scores (e.g. appendicitis diagnosis score) Screening scores (e.g. alcohol screening AUDIT C) Severity scores (e.g. Trauma Severity Score) Prognostic scores (e.g. Child Pugh variceal bleeding) Risk predictors (e.g. Framingham) Life expectancy projections Multi-endpoint prediction models … Multi-part diagnostic criteria(e.g. metabolic syndrome) Diagnostic tests Informal rules

Taxonomy of presentation Points vs. risks Scoring system Score charts Flow charts Nomograms Equations Software