title: A systematic review of clinical decision rules for epilepsy.
abstract: Clinical decision rules (CDRs) have been empirically demonstrated to improve patient satisfaction and enhance cost-effective care. The use of CDRs has not yet been robustly explored for epilepsy. We performed a systematic review of MEDLINE (from 1946) and Embase (from 1947) using Medical Subject Headings and keywords related to CDRs and epilepsy. We included original research of any language deriving, validating, or implementing a CDR using standardized definitions. Study quality was determined using a modified version of previously published criteria. A bivariate model was used to meta-analyze studies undergoing sequential derivation and validation studies. Of 2445 unique articles, 5 were determined to be relevant to this review. Three were derivation studies (three diagnostic and one therapeutic), one validation study, and one combined derivation and validation study. No implementation studies were identified. Study quality varied but was primarily of a moderate level. Two CDRs were validated and, thus, able to be meta-analyzed. Although initial measures of accuracy were high (sensitivity ~80% or above), they tended to diminish significantly in the validation studies. The pooled estimates of sensitivity and specificity both exhibited wide 95% confidence and prediction intervals that may limit their utility in routine practice. Despite the advances in therapeutic and diagnostic interventions for epilepsy, few CDRs have been developed to guide their use. Future CDRs should address common clinical scenarios such as efficient use of diagnostic tools and optimal clinical treatment decisions. Given their potential for advancing efficient, evidence-based, patient-centered healthcare, CDR development should be a priority in epilepsy.
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. Electronic address: colin.josephson@gmail.com.
authors.forename: Colin B
authors.initials: CB
authors.lastname: Josephson
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. Electronic address: sherrysandy@gmail.com.
authors.forename: Sherry
authors.initials: S
authors.lastname: Sandy
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. Electronic address: nathalie.jette@albertahealthservices.ca.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. Electronic address: tolu.sajobi@ucalgary.ca.
authors.forename: Tolulope T
authors.initials: TT
authors.lastname: Sajobi
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. Electronic address: damarsha@ucalgary.ca.
authors.forename: Deborah
authors.initials: D
authors.lastname: Marshall
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. Electronic address: swiebe@ucalgary.ca.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
mesh_terms: D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000592:standards*; D004827:Epilepsy / Q000175:diagnosis / Q000628:therapy; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Clinical prediction; Diagnosis; Epilepsy; Rules; Therapeutics