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Survey of emergency physicians’ requirements for a clinical decision rule for acute respiratory illnesses in three countries

Published online by Cambridge University Press:  11 May 2015

Jeffrey J. Perry ,
Reena Goindi ,
Cheryl Symington ,
Jamie Brehaut ,
Monica Taljaard ,
Sandra Schneider  and
Ian G. Stiell
Jeffrey J. Perry*
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Reena Goindi
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Cheryl Symington
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Jamie Brehaut
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Monica Taljaard
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
Sandra Schneider
Affiliation:
University of Rochester, Rochester, NY
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
*
Clinical Epidemiology Unit, F6, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; [email protected]

Abstract

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Objective:

There are currently no widely used guidelines to determine which older patients with acute respiratory conditions require hospital admission. This study assessed the need for clinical decision rules to help determine whether hospital admission is required for patients over 50 years for three common respiratory conditions: chronic obstructive pulmonary disease (COPD), heart failure (HF), and community-acquired pneumonia (CAP).

Design:

Postal survey.

Setting:

Emergency physicians (EPs) from the United States, Canada, and Australasia.

Participants:

A random sample of EPs from the United States, Canada, and Australasia.

Interventions:

A modified Dillman technique with a prenotification letter and up to three postal surveys.

Main Outcomes:

EP opinions regarding the need for and willingness to use clinical decision rules for emergency department (ED) patients over 50 years with COPD, HF, or CAP to predict hospital admission. We assessed the required sensitivity of each rule for return ED visit or death within 14 days.

Results:

A total of 801 responses from 1,493 surveys were received, with response rates of 55%, 60%, and 46% for Australasia, Canada, and the United States, respectively. Over 90% of EPs reported that they would consider using clinical decision rules for HF, CAP, and COPD. The median required sensitivity for death within 14 days was 97 to 98% for all conditions.

Conclusions:

EPs are likely to adopt highly sensitive clinical decision rules to predict the need for hospital admission for patients over 50 years with COPD, HF, or CAP.

Keywords

acute respiratory conditionschronic obstructive pulmonary diseaseclinical decision rulescommunity-acquired pneumoniaheart failure
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 2 , March 2012 , pp. 83 - 89
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

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