Evidence map›Paper›PMID 28082160›Full record

ArticleThe American journal of emergency medicine2017

Derivation of decision rules to predict clinically important outcomes in acute flank pain patients.

Ralph C Wang, Robert M Rodriguez, Jahan Fahimi, M Kennedy Hall, Stephen Shiboski, Tom Chi, Rebecca Smith-Bindman

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.8field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
  2. Article
  3. Pearl-unjammed: the Seattle stone maneuver for ureteropelvic junction urolithiasis.Journal of the American College of Emergency Physicians open · 2020
    Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Ralph C WangDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: ralph.wang@ucsf.edu.
Robert M RodriguezDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
Jahan FahimiDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
M Kennedy HallDivision of Emergency Medicine, University of Washington, Seattle, WA, USA.
Stephen ShiboskiDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Tom ChiDepartment of Urology, University of California, San Francisco, San Francisco, CA, USA.
Rebecca Smith-BindmanDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
University of California, San Francisco · USUniversity of Washington · US

Funding

SWL AND RENAL INJURY AND STONE COMMINUTIONP01DK043881 · NIDDK · UNIVERSITY OF WASHINGTON · PI BAILEY, MICHAEL R · 1994 to 2023
$33.5M
Risk of Cancer in Incidental Findings Identified on Ultrasound ImagingK24CA125036 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI SMITH-BINDMAN, REBECCA · 2008 to 2013
$816k
Advancing the Quality of Emergency Department Renal Stone ManagementK08HS021281 · AHRQ · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI WANG, RALPH C. · 2013 to 2017
$777k
AHRQ HHS K08 HS021281NCI NIH HHS K24 CA125036NIDDK NIH HHS P01 DK043881
6 · The paper itself

Abstract

objectiveRoutine CT for patients with acute flank pain has not been shown to improve patient outcomes, and it may unnecessarily expose patients to radiation and increased costs. As preliminary steps toward the development of a guideline for selective CT, we sought to determine the prevalence of clinically important outcomes in patients with acute flank pain and derive preliminary decision rules.

methodsWe analyzed data from a randomized trial of CT vs. ultrasonography for patients with acute flank pain from 15 EDs between October 2011 and February 2013. Clinically important outcomes were defined as inpatient admission for ureteral stones and alternative diagnoses. Clinically important stones were defined as stones requiring urologic intervention. We sought to derive highly sensitive decision rules for both outcomes.

resultsOf 2759 participants, 236 (8.6%) had a clinically important outcome and 143 (5.2%) had a clinically important stone. A CDR including anemia (hemoglobin <13.2g/dl), WBC count >11000/μl, age>42years, and the absence of CVAT had a sensitivity of 97.9% (95% CI 94.8-99.2%) and specificity of 18.7% (95% 17.2-20.2%) for clinically important outcome. A CDR including hydronephrosis, prior history of stone, and WBC count <8300/μl had a sensitivity of 98.6% (95% CI 94.5-99.7%) and specificity of 26.0% (95% 24.2-27.7%) for clinically important stone.

conclusionsWe determined the prevalence of clinically important outcomes in patients with acute flank pain, and derived preliminary high sensitivity CDRs that predict them. Validation of CDRs with similar test characteristics would require prospective enrollment of 2100 patients.

Indexed as

Decision Support TechniquesAcute PainAdultAnemiaAppendicitisColitisDiverticulitis, ColonicFemaleFlank PainHumansHydronephrosisLeukocyte CountMaleMiddle AgedPhysical ExaminationPyelonephritis

Identifiers

PMID28082160
PMCPMC5701802
OpenAlexW2560620115

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.