A discussion of how clinical prediction rules are used in medicine, with a particular focus on the Wells score for PE and the PE severity index as examples.
Brilliant way to think about this. Thank you for putting these Clinical Prediction Rules into such a great mental paradigm. I never thought to view them in a tiered approach - that's a game-changer of a concept.
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I remember once having a panic attack as a manifestation of my non-epileptic seizures(which now only occur in severe emotional stress, no physical stressors). As the patient, it was very worrisome. It started with a crushing, anginal chest pain around where the heart is. Then it started radiating about 5-10 minutes later, first to my left arm, then my right arm, then my abdomen, so far typical of a heart attack in women. Then it radiated to my legs. Even though I was 20 years old, I was still worried that it might be a heart attack. I called my mom and told her what was going on and she came home ASAP. When she saw me, she told me to calm down, that my stress is causing the pain. About a week later, I went to the doctor and told her this same story and she agreed with my mom that it was probably a panic attack as heart attack pain doesn’t typically radiate to the legs. But boy was that close to being hospitalized for possible heart attack and I hope I never have true heart attack pain.
I don't know anyone who uses it, and the original study had a very significant methodological flaw (physicians were not blinded to d-dimer when asked to assess if PE was the most likely diagnosis). Unless better evidence for it comes along, I would not recommend it as a go-to approach.
