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  1. Article ; Online: Using clinical risk models to predict outcomes: what are we predicting and why?

    Goodacre, Steve

    Emergency medicine journal : EMJ

    2023  Volume 40, Issue 10, Page(s) 728–730

    Abstract: Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically ... ...

    Abstract Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically describes the potential impact of treatment effects in model development studies. Treatment effects may lead to models failing to achieve the aim of identifying the patients most likely to benefit from intervention, and may instead identify patients who are unlikely to benefit from intervention. The paper provides practical advice to help clinicians who wish to use clinical prediction scores to assist clinical judgement rather than dictate clinical decision making.
    MeSH term(s) Humans ; Prognosis ; Risk Assessment ; Clinical Decision-Making
    Language English
    Publishing date 2023-07-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2022-213057
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Silent hypoxia in COVID-19: easy to recognise but hard to define.

    Trimble, Ashleigh / Goodacre, Steve

    Emergency medicine journal : EMJ

    2023  Volume 40, Issue 12, Page(s) 804

    MeSH term(s) Humans ; COVID-19 ; Hypoxia/etiology ; SARS-CoV-2
    Language English
    Publishing date 2023-11-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2023-213579
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Book ; Online: Evaluation of COVID-19 assessment in emergency departments and ambulance services

    Goodacre, Steve

    http://isrctn.com/

    2020  

    Keywords covid19
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Book ; Online
    DOI 10.1186/isrctn28342533
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: New guidance on initial antimicrobial treatment of sepsis.

    Goodacre, Steve / Fuller, Gordon Ward

    BMJ (Clinical research ed.)

    2022  Volume 377, Page(s) o1354

    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents/therapeutic use ; Humans ; Sepsis/drug therapy
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents
    Language English
    Publishing date 2022-06-06
    Publishing country England
    Document type Editorial
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.o1354
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  5. Article ; Online: Diagnosis and management of sepsis in the older adult.

    Goodacre, Steve / Fuller, Gordon / Conroy, Simon / Hendrikse, Clint

    BMJ (Clinical research ed.)

    2023  Volume 382, Page(s) e075585

    MeSH term(s) Humans ; Aged ; Sepsis/diagnosis ; Sepsis/therapy ; Aging
    Language English
    Publishing date 2023-07-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj-2023-075585
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Uncontrolled before-after studies: discouraged by Cochrane and the EMJ.

    Goodacre, Steve

    Emergency medicine journal : EMJ

    2015  Volume 32, Issue 7, Page(s) 507–508

    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Cephalosporins/therapeutic use ; Drug Utilization/statistics & numerical data ; Fluoroquinolones/therapeutic use ; Humans
    Chemical Substances Anti-Bacterial Agents ; Cephalosporins ; Fluoroquinolones
    Language English
    Publishing date 2015-07
    Publishing country England
    Document type Comment ; Editorial
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2015-204761
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Composite Outcomes in Clinical Prediction Modeling: Are We Trying to Predict Apples and Oranges?

    Dash, Kieran / Goodacre, Steve / Sutton, Laura

    Annals of emergency medicine

    2022  Volume 80, Issue 1, Page(s) 12–19

    Abstract: Composite outcomes are widely used in clinical research. Existing literature has considered the pros and cons of composite outcomes in clinical trials, but their extensive use in clinical prediction has received much less attention. Clinical prediction ... ...

    Abstract Composite outcomes are widely used in clinical research. Existing literature has considered the pros and cons of composite outcomes in clinical trials, but their extensive use in clinical prediction has received much less attention. Clinical prediction assists decision-making by directing patients with higher risks of adverse outcomes toward interventions that provide the greatest benefits to those at the greatest risk. In this article, we summarize our existing understanding of the advantages and disadvantages of composite outcomes, consider how these relate to clinical prediction, and highlight the problem of key predictors having markedly different associations with individual components of the composite outcome. We suggest that a "composite outcome fallacy" may occur when a clinical prediction model is based on strong associations between key predictors and one component of a composite outcome (such as mortality) and used to direct patients toward intervention when these predictors actually have an inverse association with a more relevant component of the composite outcome (such as the use of a lifesaving intervention). We propose that clinical prediction scores using composite outcomes should report their accuracy for key components of the composite outcome and examine for inconsistencies among predictor variables.
    MeSH term(s) Humans ; Models, Statistical ; Prognosis
    Language English
    Publishing date 2022-03-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2022.01.046
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  8. Article ; Online: Research priorities for prehospital care of older patients with injuries: scoping review.

    Harthi, Naif / Goodacre, Steve / Sampson, Fiona / Alharbi, Rayan

    Age and ageing

    2022  Volume 51, Issue 5

    Abstract: Background and objective: There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older ... ...

    Abstract Background and objective: There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature.
    Methods: We undertook a systematic scoping review guided by the Arksey and O'Malley framework and reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between 2001 and 2021. Study selection criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles. A data-charting form was then developed to facilitate thematic analysis. Narrative synthesis then involved identifying major themes and subthemes from the data.
    Results: We identified and reviewed 65 studies, and included 25. We identified five categories: 'field triage', 'ageing impacts', 'decision-making', 'paramedic' awareness' and 'paramedic's behaviour'. Undertriage and overtriage (sensitivity and specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes.
    Conclusion: This is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. Field-triage tools, paramedics' knowledge about injuries in the older population, and understanding of paramedics' negative behaviours towards older patients were identified as key research priorities.
    MeSH term(s) Allied Health Personnel ; Humans ; Patient Selection ; Research ; Risk Assessment ; Triage
    Language English
    Publishing date 2022-05-23
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afac108
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    Zs.MO 448: Show issues

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  9. Article ; Online: Trial registration: must take place before or at the onset of enrolment.

    Goodacre, Steve

    Emergency medicine journal : EMJ

    2014  Volume 31, Issue 3, Page(s) 176

    MeSH term(s) Acetaminophen/administration & dosage ; Analgesics/administration & dosage ; Analgesics, Non-Narcotic/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Female ; Humans ; Ketoprofen/administration & dosage ; Ketoprofen/analogs & derivatives ; Low Back Pain/drug therapy ; Male ; Migraine Disorders/drug therapy ; Morphine/administration & dosage ; Tromethamine/administration & dosage
    Chemical Substances Analgesics ; Analgesics, Non-Narcotic ; Anti-Inflammatory Agents, Non-Steroidal ; Tromethamine (023C2WHX2V) ; Acetaminophen (362O9ITL9D) ; Morphine (76I7G6D29C) ; Ketoprofen (90Y4QC304K) ; dexketoprofen trometamol (N674F7L21E)
    Language English
    Publishing date 2014-03
    Publishing country England
    Document type Comment ; Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2014-203566
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  10. Article ; Online: Effectiveness and cost effectiveness of pharmacological thromboprophylaxis for medical inpatients: decision analysis modelling study.

    Davis, Sarah / Goodacre, Steve / Horner, Daniel / Pandor, Abdullah / Holland, Mark / de Wit, Kerstin / Hunt, Beverley J / Griffin, Xavier Luke

    BMJ medicine

    2024  Volume 3, Issue 1, Page(s) e000408

    Abstract: Objective: To determine the balance of costs, risks, and benefits for different thromboprophylaxis strategies for medical patients during hospital admission.: Design: Decision analysis modelling study.: Setting: NHS hospitals in England.: ... ...

    Abstract Objective: To determine the balance of costs, risks, and benefits for different thromboprophylaxis strategies for medical patients during hospital admission.
    Design: Decision analysis modelling study.
    Setting: NHS hospitals in England.
    Population: Eligible adult medical inpatients, excluding patients in critical care and pregnant women.
    Interventions: Pharmacological thromboprophylaxis (low molecular weight heparin) for all medical inpatients, thromboprophylaxis for none, and thromboprophylaxis given to higher risk inpatients according to risk assessment models (Padua, Caprini, IMPROVE, Intermountain, Kucher, Geneva, and Rothberg) previously validated in medical cohorts.
    Main outcome measures: Lifetime costs and quality adjusted life years (QALYs). Costs were assessed from the perspective of the NHS and Personal Social Services in England. Other outcomes assessed were incidence and treatment of venous thromboembolism, major bleeds including intracranial haemorrhage, chronic thromboembolic complications, and overall survival.
    Results: Offering thromboprophylaxis to all medical inpatients had a high probability (>99%) of being the most cost effective strategy (at a threshold of £20 000 (€23 440; $25 270) per QALY) in the probabilistic sensitivity analysis, when applying performance data from the Padua risk assessment model, which was typical of that observed across several risk assessment models in a medical inpatient cohort. Thromboprophylaxis for all medical inpatients was estimated to result in 0.0552 additional QALYs (95% credible interval 0.0209 to 0.1111) while generating cost savings of £28.44 (-£47 to £105) compared with thromboprophylaxis for none. No other risk assessment model was more cost effective than thromboprophylaxis for all medical inpatients when assessed in deterministic analysis. Risk based thromboprophylaxis was found to have a high (76.6%) probability of being the most cost effective strategy only when assuming a risk assessment model with very high sensitivity is available (sensitivity 99.9% and specificity 23.7%
    Conclusions: Offering pharmacological thromboprophylaxis to all eligible medical inpatients appears to be the most cost effective strategy. To be cost effective, any risk assessment model would need to have a very high sensitivity resulting in widespread thromboprophylaxis in all patients except those at the very lowest risk, who could potentially avoid prophylactic anticoagulation during their hospital stay.
    Language English
    Publishing date 2024-02-21
    Publishing country England
    Document type Journal Article
    ISSN 2754-0413
    ISSN (online) 2754-0413
    DOI 10.1136/bmjmed-2022-000408
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