Developing an international register of clinical prediction rules for use in primary care: a descriptive analysis

Abstract

Purpose: We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics.

Methods: To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied.

Results: Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study), resulting in 989 individual studies. In all, 434 unique rules had gone through derivation; however, only 54.8% had been validated and merely 2.8% had undergone analysis of their impact on either the process or outcome of clinical care. The rules most commonly pertained to cardiovascular disease, respiratory, and musculoskeletal conditions. They had most often been studied in the primary care or emergency department settings.

Conclusions: Many clinical prediction rules have been derived, but only about half have been validated and few have been assessed for clinical impact. This lack of thorough evaluation for many rules makes it difficult to retrieve and identify those that are ready for use at the point of patient care. We plan to develop an international web-based register of clinical prediction rules and computer-based clinical decision support systems.

Keywords: clinical decision support systems; clinical prediction rule; decision aid; decision making; primary care; score card.

Figure 1

Flow diagram of articles on clinical prediction rules in primary care. Note: The 745 articles included in our review contained data on 895 original studies as many articles described more than 1 clinical prediction rule study. Analyses pertain to 434 unique clinical prediction rules. ^a Articles did not pertain to a clinical prediction rule, were not relevant to primary care, or both.

Figure 2

Clinical prediction rule studies, split by decade reported and stage of development of the rule (N = 895). Note: Few studies were reported before 1980; therefore, we grouped these studies into a broader time period (1965–1979).

Figure 3

Broad clinical domains for the clinical prediction rule studies, split by stage of development of the rule (N = 895). Note: Studies were classified according to the International Classification of Primary Care, 2nd Edition (ICPC-2).