Your browser doesn't support javascript.
loading
Clinical judgment is a cornerstone for validating and using clinical prediction rules: a head-to-head study on ambulation outcomes for spinal cord injured patients.
Pelletier-Roy, Rémi; Richard-Denis, Andréane; Jean, Stéphanie; Bourassa-Moreau, Étienne; Fleury, Jean; Beauchamp-Vien, Geneviève; Bégin, Jean; Mac-Thiong, Jean-Marc.
Afiliación
  • Pelletier-Roy R; Université de Montréal, Faculty of Medicine, Montréal, QC, Canada.
  • Richard-Denis A; Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada.
  • Jean S; Université de Montréal, Faculty of Medicine, Montréal, QC, Canada.
  • Bourassa-Moreau É; Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada.
  • Fleury J; Université de Montréal, Faculty of Medicine, Montréal, QC, Canada.
  • Beauchamp-Vien G; Institut de réadaptation Lindsay-Gingras de Montréal, Montréal, QC, Canada.
  • Bégin J; Université de Montréal, Faculty of Medicine, Montréal, QC, Canada.
  • Mac-Thiong JM; Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada.
Spinal Cord ; 59(10): 1104-1110, 2021 Oct.
Article en En | MEDLINE | ID: mdl-33963271
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: Clinical prediction rules (CPRs) are an effervescent topic in the medical literature. Recovering ambulation after a traumatic spinal cord injury (tSCI) is a priority for patients and multiple CPRs have been proposed for predicting ambulation outcomes. Our objective is to confront clinical judgment to an established CPR developed for patients with tSCI. SETTINGS: Level one trauma center specialized in tSCI and its affiliated rehabilitation center. METHOD: In this retrospective comparative study, six physicians had to predict the ambulation outcome of 68 patients after a tSCI based on information from the acute hospitalization. Ambulation was also predicted according to the CPR of van Middendorp (CPR-vM). The success rate of the CPR-vM and clinicians to predict ambulation was compared using criteria of 5% for defining clinical significance, and a level of statistical significance of 0.05 for bilateral McNemar tests. RESULTS: There was no statistical difference between the overall performance of physicians (success rate of 79%) and of the CPR-vM (81%) for predicting ambulation. The differences between the CPR-vM and physicians varied clinically and significantly with the level of experience, clinical setting, and field of expertise. CONCLUSION: Confronting CPRs with the judgment of a group of clinicians should be an integral part of the design and validation of CPRs. Head-to-head comparison of CPRs with clinicians is also a cornerstone for defining the optimal strategy for translation into the clinical practice, and for defining which clinician and specific clinical context would benefit from using the CPR.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Caminata Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Spinal Cord Asunto de la revista: NEUROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Caminata Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Spinal Cord Asunto de la revista: NEUROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido