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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

References

REFERENCES

1.Garibaldi, RA. Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact. Am J Med 1985;78(6B):32–7, doi:10.1016/0002-9343(85)90361-4.Google Scholar
2.Mandell, LA, Bartlett, JG, Dowell, SF, et al. Update of practice guidelines for the management of communityacquired pneumonia in immunocompetent adults. Clin Infect Dis 2003;37:1405–33, doi:10.1086/380488.CrossRefGoogle ScholarPubMed
3.Tsuyuki, RT, Shibata, MC, Nilsson, C, Hervas-Malo, M. Contemporary burden of llness of congestive heart failure in Canada. Can J Cardiol 2003;19:436–8.Google Scholar
4.Krumholz, HM, Parent, EM, Tu, N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med 1997;157:99–104, doi:10.1001/archinte.1997.00440220103013.Google Scholar
5.Mannino, DM, Homa, DM, Akinbami, LJ, et al. Chronic obstructive pulmonary disease surveillance—United States, 1971–2000. Atlanta, GA: US Department of Health and Human Services; 2000.Google Scholar
6.Tsai, A, Kallsen, G. Epidemiology of pediatric prehospital care. Ann Emerg Med 1987;16:284–92, doi:10.1016/S0196-0644(87)80173-7.Google Scholar
7.Stiell, IG, Wells, GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med 1999;33:437–47, doi:10.1016/S0196-0644(99)70309-4.Google Scholar
8.Laupacis, A, Sekar, N, Stiell, IG. Clinical Prediction Rules: a review and suggested modifications of methodological standards. JAMA 1997;277:488–94, doi:10.1001/jama.1997.03540300056034.Google Scholar
9.Wasson, JH, Sox, HC, Neff, RK, Goldman, L. Clinical Prediction Rules: applications and methodological standards. N Engl J Med 1985;313:793–9, doi:10.1056/NEJM198509263131306.CrossRefGoogle ScholarPubMed
10.Fine, MJ, Auble, TE, Yealy, DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243–50, doi:10.1056/NEJM199701233360402.Google Scholar
11.McAlister, FA, Lawson, FM, Teo, KK, Armstrong, PW. A systematic review of randomized trials of disease management programs in heart failure. Am J Med 2001;110:378–84, doi:10.1016/S0002-9343(00)00743-9.Google Scholar
12.Dillman, DA. Mail and Internet surveys: the tailored design method. 2nd ed. New York: Wiley; 2000.Google Scholar
13.Auble, TE, Hsieh, M, Gardner, W, et al. A prediction rule to identify low-risk patients with heart failure. Acad Emerg Med 2005;12:514–21, doi:10.1111/j.1553-2712.2005.tb00891.x.Google Scholar
14.Cowie, MR, Wood, DA, Coats, AJ, et al. Survival of patients with a new diagnosis of heart failure: a population based study. Heart 2000;83:505–10, doi:10.1136/heart.83.5.505.Google Scholar
15.Lee, DS, Johansen, H, Gong, Y, et al. Regional outcomes of heart failure in Canada. Can J Cardiol 2004;20:599–607.Google Scholar
16.Tsuyuki, RT, Richter, CA, Rowe, BH. Practice patterns and outcomes in patients presenting to the emergency department with acute heart failure. Can J Cardiol 2005;21(C):93C.Google Scholar
17.Brewer, AV, Burton, JH, Strout, TD. Emergency department patients with acutely decompensated congestive heart failure: is discharge a safe disposition? Acad Emerg Med 2003;10:544, doi:10.1197/aemj.10.5.544-a.CrossRefGoogle Scholar
18.Rame, JE, Sheffield, MA, Dries, DL, et al. Outcomes after emergency department discharge with a primary diagnosis of heart failure. Am Heart J 2001;142:714–9, doi:10.1067/mhj.2001.118473.CrossRefGoogle ScholarPubMed
19.Feinleib, M, Rosenberg, HM, Collins, JG, et al. Trends in COPD morbidity and mortality in the United States. Am Rev Respir Dis 1989;140(3 Pt 2):S9–18.Google Scholar
20.Seemungal, TAR, Donaldson, GC, Paul, EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1418–22.CrossRefGoogle ScholarPubMed
21.American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152(5 Pt 2):S77–120.Google Scholar
22.Rosychuk, RJ, Metes, D, Voaklander, DC, et al. COPD presentations to emergency departments in Alberta Canada, a population-based study [abstract], Can J Emerg Med 2009;11:269.Google Scholar
23.Black, ER, Mushlin, AI, Griner, PF, et al. Predicting the need for hospitalization of ambulatory patients with pneumonia. J Gen Intern Med 1991;6:394–400, doi:10.1007/BF02598159.Google Scholar
24.Fine, MJ, Smith, DN, Singer, DE. Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study. Am J Med 1990;89:713–21, doi:10.1016/0002-9343(90)90211-U.Google Scholar
25.Stiell, IG, Wells, GA, Hoag, RA, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA 1997;278:2075–8, doi:10.1001/jama.1997.03550230051036.Google Scholar
26.Stiell, IG, McKnight, RD, Greenberg, GH, et al. Implementation of the Ottawa Ankle Rules. JAMA 1994;271:827–32, doi:10.1001/jama.1994.03510350037034.Google Scholar
27.Stiell, IG, Wells, GA, Laupacis, A, et al. A multicentre trial to introduce clinical decision rules for the use of radiography in acute ankle injuries. Br Med J 1995;311:594–7, doi:10.1136/bmj.311.7005.594.Google Scholar
28.Stiell, IG, Clement, C, Rowe, BH, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA 2005;294:1511–8, doi:10.1001/jama.294.12.1511.Google Scholar
29.Graham, ID, Logan, J, Harrison, MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006;26:13–24, doi:10.1002/chp.47.CrossRefGoogle ScholarPubMed
30.Godin, G, Belanger-Gravel, A, Eccles, M, Grimshaw, J. Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci 2008;3:36, doi:10.1186/1748-5908-3-36.CrossRefGoogle ScholarPubMed
31.Canadian Medical Association. Number of physicians by specialty and age, Canada, 2007. Ottawa: Canadian Medical Association; 2007.Google Scholar
32.Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2007. Ottawa: Canadian Medical Association; 2007.Google Scholar
33.Cummings, SM, Savitz, LA, Konrad, TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001;35:1347–55.Google Scholar
34.Asch, D, Jedrziewski, K, Christakis, N. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;10:1129–36, doi:10.1016/S0895-4356(97)00126-1.Google Scholar