Derivation of a clinical decision rule to exclude cerebral venous sinus thrombosis in emergency department patients: A retrospective cohort study.

OBJECTIVE: To derive a clinical decision rule to exclude cerebral venous sinus thrombosis (CVST) in the ED. A secondary aim was to derive a rule that incorporated clinical parameters and the non-contrast CT brain. METHODS: Single-centre, retrospective cohort study. Patients suspected of CVST were identified from the radiology database for CT/MR venograms. Clinical features included in the rule were determined by literature review. The presence of these features in participants was determined by chart review. Variables were tested for univariate association with CVST using logistic regression. Variable selection was accomplished using a forward-stepwise process, calculating the sensitivity/specificity of a rule containing the variable of most significance, then repeating the process after adding the next most significant variable. RESULTS: Forty-five out of 912 participants had confirmed CVST. The primary clinical rule was answering 'no' to all the following: any prothrombotic risk factor, age ≥54 years, confusion: sensitivity 95.6% (95% confidence interval [CI] 84.9-99.5%), specificity 40.9% (95% CI 37.6-44.2%), negative predictive value 99.4% (95% CI 97.9-99.9%) and positive predictive value 7.7% (95% CI 7.1-8.3%). The rule classified 39.5% of participants as CVST ruled out. The rule incorporating the non-contrast CT brain was answering 'no' to all the following: abnormal non-contrast CT brain, any prothrombotic risk-factor, age ≥54 years, confusion: sensitivity 100.0% (95% CI 91.6-100.0%), specificity 42.0% (95% CI 38.7-45.4%), negative predictive value 100.0% (95% CI not calculated) and positive predictive value 7.8% (95% CI 7.4-8.2%). The rule classified 40.0% of participants as CVST ruled out. CONCLUSIONS: A clinical decision rule was derived to rule out CVST. These results require validation before adoption into clinical practice.

People attending pulmonary rehabilitation demonstrate a substantial engagement with technology and willingness to use telerehabilitation: a survey.

QUESTIONS: What is the level of technology engagement by people attending pulmonary rehabilitation? Are participant demographics and level of technology engagement associated with willingness to use telerehabilitation? DESIGN: A cross-sectional, multicentre study involving quantitative survey analysis. PARTICIPANTS: Convenience sample of people with chronic respiratory disease attending a pulmonary rehabilitation program, maintenance exercise class or support group. OUTCOME MEASURES: The survey assessed the participants' level of technology engagement (access to and use of devices), self-rated skill competence, access to online health information and willingness to use telerehabilitation. RESULTS: Among the 254 people who were invited, all agreed to complete the survey (100% response rate). Among these 254 respondents, 41% were male, the mean age was 73 years (SD 10), and the mean forced expiratory volume in 1second (FEV1) was 59% predicted (SD 23). Ninety-two percent (n=233) of participants accessed at least one technological device, of whom 85% (n=198) reported regularly using mobile phones and 70% (n=164) regularly used a computer or tablet. Fifty-seven percent (n=144) of participants self-rated their technology skill competence as good and 60% (n=153) of all participants were willing to use telerehabilitation. The multivariate regression model found regular computer use (OR 3.14, 95% CI 1.72 to 5.71) and regular mobile phone use (OR 2.83, 95% CI 1.32 to 6.09) were most associated with a willingness to use telerehabilitation. CONCLUSION: People attending metropolitan pulmonary rehabilitation, maintenance exercise classes and support groups had substantial technology engagement, with high device access and use, and good self-rated technology competence. The majority of participants were willing to use telerehabilitation, especially if they were regular users of technology devices. [Seidman Z, McNamara R, Wootton S, Leung R, Spencer L, Dale M, Dennis S, McKeough Z (2017) People attending pulmonary rehabilitation demonstrate a substantial engagement with technology and willingness to use telerehabilitation: a survey. Journal of Physiotherapy 63: 175-181].