Evaluation of the Canadian Clinical Practice Guidelines Risk Prediction Tool for Acute Aortic Syndrome: The RIPP Score.

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Robert Ohle, Sarah McIsaac, Madison Van Drusen, Aaron Regis, Owen Montpellier, Mackenzie Ludgate, Oluwadamilola Bodunde, David W Savage, Krishan Yadav
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引用次数: 1

Abstract

Introduction: Acute aortic syndrome (AAS) is a rare clinical syndrome with a high mortality rate. The Canadian clinical practice guideline for the diagnosis of AAS was developed in order to reduce the frequency of misdiagnoses. As part of the guideline, a clinical decision aid was developed to facilitate clinician decision-making (RIPP score). The aim of this study is to validate the diagnostic accuracy of this tool and assess its performance in comparison to other risk prediction tools that have been developed.

Methods: This was a historical case-control study. Consecutive cases and controls were recruited from three academic emergency departments from 2002-2020. Cases were identified through an admission, discharge, or death certificated diagnosis of acute aortic syndrome. Controls were identified through presenting complaint of chest, abdominal, flank, back pain, and/or perfusion deficit. We compared the clinical decision tools' C statistic and used the DeLong method to test for the significance of these differences and report sensitivity and specificity with 95% confidence intervals.

Results: We collected data on 379 cases of acute aortic syndrome and 1340 potential eligible controls; 379 patients were randomly selected from the final population. The RIPP score had a sensitivity of 99.7% (98.54-99.99). This higher sensitivity resulted in a lower specificity (53%) compared to the other clinical decision aids (63-86%). The DeLong comparison of the C statistics found that the RIPP score had a higher C statistic than the ADDRS (-0.0423 (95% confidence interval -0.07-0.02); P < 0.0009) and the AORTAs score (-0.05 (-0.07 to -0.02); P = 0.0002), no difference compared to the Lovy decision tool (0.02 (95% CI -0.01-0.05 P < 0.25)) and decreased compared to the Von Kodolitsch decision tool (0.04 (95% CI 0.01-0.07 P < 0.008)).

Conclusion: The Canadian clinical practice guideline's AAS clinical decision aid is a highly sensitive tool that uses readily available clinical information. It has the potential to improve diagnosis of AAS in the emergency department.

Abstract Image

Abstract Image

评估加拿大临床实践指南急性主动脉综合征风险预测工具:RIPP评分。
简介:急性主动脉综合征(AAS)是一种罕见的临床综合征,死亡率高。加拿大临床实践指南的诊断AAS是为了减少误诊的频率。作为指南的一部分,开发了临床决策辅助工具以促进临床医生的决策(RIPP评分)。本研究的目的是验证该工具的诊断准确性,并与已开发的其他风险预测工具进行比较,评估其性能。方法:采用历史病例对照研究。2002-2020年从三个学术急诊科招募连续病例和对照。病例是通过急性主动脉综合征的入院、出院或死亡诊断来确定的。对照组通过提出胸痛、腹痛、腰痛、背痛和/或灌注不足的主诉来确定。我们比较了临床决策工具的C统计量,并使用DeLong方法检验这些差异的显著性,并以95%的置信区间报告敏感性和特异性。结果:我们收集了379例急性主动脉综合征和1340例潜在符合条件的对照者的数据;从最终人群中随机抽取379例患者。RIPP评分敏感性为99.7%(98.54 ~ 99.99)。与其他临床决策辅助工具(63-86%)相比,较高的敏感性导致较低的特异性(53%)。DeLong比较C统计量发现,RIPP评分的C统计量高于ADDRS(-0.0423(95%可信区间-0.07-0.02);P < 0.0009),主动脉评分(-0.05 (-0.07 ~ -0.02);P = 0.0002),与Lovy决策工具相比无差异(0.02 (95% CI -0.01-0.05 P < 0.25)),与Von Kodolitsch决策工具相比下降(0.04 (95% CI 0.01-0.07 P < 0.008))。结论:加拿大临床实践指南的AAS临床决策辅助工具是一种高度敏感的工具,可以使用现成的临床信息。它有可能提高急诊科对AAS的诊断。
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来源期刊
Emergency Medicine International
Emergency Medicine International EMERGENCY MEDICINE-
CiteScore
0.10
自引率
0.00%
发文量
187
审稿时长
17 weeks
期刊介绍: Emergency Medicine International is a peer-reviewed, Open Access journal that provides a forum for doctors, nurses, paramedics and ambulance staff. The journal publishes original research articles, review articles, and clinical studies related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.
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