PubMed · 14613443
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Zafar Hakim. Using decision-analytic models wisely.. https://doi.org/10.18553/jmcp.2003.9.5.449
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This paper describes a generalized methodology that enables the translation of expert knowledge about any complex process involved in a remedial decision into easy-to-use decision tools. The methodology is applied to evaluate reductive dechlorination as a remedial possibility at sites contaminated with trichloroethene (TCE), building on an existing protocol/scoring system put forth by the US Air Force and the US EPA. An alternate scoring system is proposed, which has two major advantages, namely that it: (i) attributes relative weights to findings based on expert beliefs; and (ii) systematically includes negative weights for negative findings. The ability of the proposed scoring system to assess the bioattenuation potential of TCE is demonstrated using data from extensively studied sites.
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BACKGROUND: The Ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography. PURPOSE: To summarize evidence about the accuracy of the Ottawa knee rule. DATA SOURCES: Relevant English- and non-English-language articles were identified from PreMEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL (1982-2003), BIOSIS (1990-2003), the Cochrane Library (2002, Issue 3), the Science Citation Index database, reference lists of included studies, and experts. STUDY SELECTION: Articles were included if they reported enough information to determine the sensitivity and specificity of the Ottawa knee rule for detecting fractures confirmed either radiologically or in combination with follow-up. DATA EXTRACTION: Two reviewers independently extracted data on study samples, the ways that the Ottawa knee rule was used, and methodologic characteristics of studies. DATA SYNTHESIS: Of 11 identified studies, 6 involving 4249 adult patients were considered appropriate for pooled analysis. The pooled negative likelihood ratio was 0.05 (95% CI, 0.02 to 0.23), the pooled sensitivity was 98.5% (CI, 93.2% to 100%), and the pooled specificity was 48.6% (CI, 43.4% to 51.0%). CONCLUSION: A negative result on an Ottawa knee rule test accurately excluded knee fractures after acute knee injury. However, because the rule is calibrated toward 100% sensitivity and actual fracture prevalences are usually low, large-scale, multicentered studies are still needed to establish the cost-effectiveness of routinely implementing the rule.