Embed Size (px)
Citation preview
Department of Primary Health CareUniversity of Oxford
Matthew ThompsonCo-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)
Heartrate(bpm)
Temperature(Celsius)
Xin Liu, M.Sc. dissertation, University of Oxford 2009
What is a normal heart rate in a child with a fever?
Age 1 to 2 years
80
90
100
110
120
130
140
150
160
170
180
190
200
210
36.236.436.636.837.037.237.437.637.838.038.238.438.638.839.039.239.439.639.840.040.2
Temperature (Celsius)
Hea
rt r
ate
(bea
ts/m
inu
te)
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
