P120: Clinical decision rule evidence ranking and use in clinical practice

Abstract

Introduction: The 2007 SAEM Knowledge Translation consensus conference proposed areas of research in evidence-based clinical algorithms (EBCAs) using clinical decision rules (CDRs) and practice guidelines (CPGs). This project sought to explore the evidence awareness and utilization of various clinical decision rules (CDRs) in emergency medicine (EM) practice. This project sought to explore the evidence awareness and utilization of various clinical decision rules (CDRs) in emergency medicine (EM) practice. Methods: An international survey was administered via international EM organizations using modified Dillman methods. Categories of CDRs included imaging (7), infections (3), neurology (2), venous thromboembolism (VTE; 2), and other (2). Evidence levels were queried using JAMA User’s Guide CDR rating scales (Levels I-IV). Confidence with supporting evidence and utilization of CDRs in practice were assessed on 7-point Likert scales. Correlation of evidence understanding and practice utilization were calculated using Spearman rho methods. Results: The majority of respondents (n=378) were Canadian (72%), <15 years full practice (64%), residency trained (90%), and trained in CDR methods (73%). Evidence ratings were deemed high for all CDRs, although confidence in evidence ratings and practice utilization were more variable for specific rules. Comfort with evidence ranking and utilization in clinical practice were highly correlated (ρ<0.0002). Conclusion: Among Canadian residency CDR trained physicians, evidence ranking is strongly correlated with use in self-reported clinical practice. There is insufficient data from non-Canadian respondents to draw firm correlations. Their remains opportunity to fully disseminate high quality CDRs and encourage incorporation into EBCA practice.