Terminology: Is it just semantics? Grant Dex

What are Clinical Prediction Rules/Guides? clinical tools that quantify the contribution of the history, physical examination and diagnostic tests and stratify patients according to the probability of having a target disorder clinical tools that quantify the contribution of the history, physical examination and diagnostic tests and stratify patients according to the probability of having a target disorder

Commonly used terms: Clinical decision aid Clinical decision aid Clinical decision guide Clinical decision guide Clinical prediction guide Clinical prediction guide Clinical prediction rule Clinical prediction rule Clinical decision rule Clinical decision rule Clinical prediction tool Clinical prediction tool Clinical decision tool Clinical decision tool

Semantics? Does it matter what term we use? Does it matter what term we use? Do they mean the same thing? Do they mean the same thing? Can they be used interchangeably? Can they be used interchangeably? Is clinical prediction the same as clinical decision-making? Is clinical prediction the same as clinical decision-making?

Semantics? Is a “Rule” the same as a “Guide” or “Tool” Is a “Rule” the same as a “Guide” or “Tool” Different terminology for different situations (diagnosis, prognosis)? Different terminology for different situations (diagnosis, prognosis)? But, is there a single GENERIC term we can use? But, is there a single GENERIC term we can use?

Which would you choose? Clinical - decision aid decision aid decision guide decision guide prediction guide prediction guide prediction rule prediction rule decision rule decision rule prediction tool prediction tool decision tool decision tool

Use of terms in the literature- Precedents Clinical prediction rules. Applications and methodological standards: JH Wasson et al- NEJM, 1985 Clinical prediction rules. Applications and methodological standards: JH Wasson et al- NEJM, 1985 Clinical prediction rules. A review and suggested modifications of methodological standards: A Laupacis, - JAMA, Am Med Assoc Clinical prediction rules. A review and suggested modifications of methodological standards: A Laupacis, - JAMA, Am Med Assoc

Diagnostic prediction rules: principles, requirements and pitfalls. JA Knottnerus - Primary care, 1995 Diagnostic prediction rules: principles, requirements and pitfalls. JA Knottnerus - Primary care, 1995 Users' guides to the medical literature: XXII: how to use articles about clinical decision Users' guides to the medical literature: XXII: how to use articles about clinical decision rules. TG McGinn, GH Guyatt, PC Wyer, CD Naylor, IG - JAMA, Am Med Assoc

Understanding articles describing Understanding articles describing clinical prediction tools AG Randolph, GH Guyatt, JE Calvin, G Doig - Critical care medicine, 1998 Evidence-based diagnosis: a handbook of clinical prediction rules By Mark H. Ebell Evidence-based diagnosis: a handbook of clinical prediction rules By Mark H. Ebell

Diagnosis of left ventricular systolic dysfunction (LVSD): development and validation of a clinical prediction rule in primary care. T Fahey, FM Sullivan et al - Family Practice, 2007 Diagnosis of left ventricular systolic dysfunction (LVSD): development and validation of a clinical prediction rule in primary care. T Fahey, FM Sullivan et al - Family Practice, 2007 PubMed Clinical Queries PubMed Clinical Queries “clinical prediction guides” Haynes et al “clinical prediction guides” Haynes et al

PubMed Search [All Fields] "clinical prediction guide" Results: 9 "clinical prediction guide" Results: 9 "clinical prediction tool" Results: 10 "clinical prediction tool" Results: 10 "clinical decision rule" Results: 151 "clinical decision rule" Results: 151 "clinical prediction rule" Results: 232 "clinical prediction rule" Results: 232

What do GPs & others think? Glasgow RCGP Conference: Glasgow RCGP Conference: 76/100 chose Clinical Prediction GUIDE 76/100 chose Clinical Prediction GUIDE Notts Division of Primary Care: Notts Division of Primary Care: Researchers - Clinical Prediction Rule 24/24 Researchers - Clinical Prediction Rule 24/24 Clinical Lecturers/Teaching Fellows Clinical Lecturers/Teaching Fellows Clinical Prediction GUIDE 27/33 ~ 82% Different perspectives?

Doodle Poll – 60 responses Clinical decision aid - 10 Clinical decision guide - 2 Clinical prediction guide - 26 Clinical prediction rule – 19 Clinical decision rule - 3

Doodle comments “I prefer clinical decision aid (or guide) as these tools aid in the decision making process but the final decision should be a clinical one as actual patients should be treated as individuals.” “I prefer clinical decision aid (or guide) as these tools aid in the decision making process but the final decision should be a clinical one as actual patients should be treated as individuals.”

Doodle Comments “I am uncomfortable with the use of "rule" - Its connotations are that there is no option to "disobey" even if it is going to benefit/harm a patient.” “I'd opt for CPG because its: prediction not decision and a guide not a rule.” “I'd opt for CPG because its: prediction not decision and a guide not a rule.”

Further comments “I use clinical prediction rule if it estimates probability of diagnosis or prognosis. I think clinical decision rule if the probability estimate is then linked explicitly to a management recommendation. So I view cardiovascular risk functions such as Framingham, Qrisk etc at prognostic clinical prediction rules, whilst the Ottawa ankle rule is a clinical decision rule because of advice about whether or not to x ray ankle”

So... Discussion! Is it important what terms we use? Is it important what terms we use? Decision vs. Prediction Decision vs. Prediction Clinical context Clinical context Rule vs. Guide Rule vs. Guide What Generic term? What Generic term?