department of primary health care university of oxford matthew thompson co-director, madox...

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