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Objectives: Clinical prediction rules are used to discriminate patients with locomotive syndrome and may enable early detection. This study aimed to validate the clinical predictive rules for locomotive syndrome in community-dwelling older adults. Methods: We assessed the clinical prediction rules for locomotive syndrome in a cross-sectional setting. The age, sex, and body mass index of participants were recorded. Five physical function tests–grip strength, single-leg standing time, timed up-and-go test, and preferred and maximum walking speeds–were measured as predictive factors. Three previously developed clinical prediction models for determining the severity of locomotive syndrome were assessed using a decision tree analysis. To assess validity, the sensitivity, specificity, likelihood ratio, and post-test probability of the clinical prediction rules were calculated using receiver operating characteristic curve analysis for each model. Results: Overall, 280 older adults were included (240 women; mean age, 74.8 ± 5.2 years), and 232 (82.9%), 68 (24.3%), and 28 (10.0%) participants had locomotive syndrome stages ≥ 1, ≥ 2, and = 3, respectively. The areas under the receiver operating characteristics curves were 0.701, 0.709, and 0.603, in models 1, 2, and 3, respectively. The accuracies of models 1 and 2 were moderate. Conclusions: These findings indicate that the models are reliable for community-dwelling older adults.

Abstract Objectives The original STONE score was designed to predict the presence of uncomplicated renal colic and the corresponding absence of alternate serious etiologies. It was retrospectively derived and prospectively validated and resulted in five variables: Sex (male gender), Timing (acute onset of pain), “Origin” (non‐Black race), Nausea/vomiting (present), and Erythrocytes (microscopic hematuria). With recent increased awareness of the potential adverse impacts of including race (a socially constructed identity) in clinical prediction rules, we sought to determine if a revised STONE score without race could be constructed with similar diagnostic accuracy. Methods We used data from the original STONE score that utilized retrospective data on patients with confirmed kidney stone by computed tomography (CT) to derive a clinical prediction rule as well as prospective data to validate the score. These data were used to construct a revised STONE score after removing race as a variable. We performed univariate and multivariable logistic regression and compared the old and new STONE scores (including multivariable, integral, and three‐level risk) using the area under the receiver operating characteristic curve (AUC) and misclassification rates. Results After the elimination of race, multivariable logistic regression revealed that gross hematuria was the next strongest feasible variable for the prediction of ureteral stone. This was incorporated into a revised STONE score by substituting “obvious hematuria” for “origin” (formerly race). The revised STONE score had similar predictive accuracy to the original STONE score: AUC 0.85 versus 0.86 (95% confidence interval [CI]: 0.82–0.87 and 0.79–0.93); misclassification rates were also unchanged, 0.23 versus 0.23 (95% CI: 0.20–0.25 and 0.20–0.25). Conclusions We modified the STONE score to remove race and include “obvious hematuria” without losing clinical accuracy. Considering the potential adverse effects of propagating racial bias in clinical algorithms, we recommend using the revised STONE score. Future research could investigate the potential contributions of social drivers of health (SDOH) to the diagnosis of kidney stone.

Purpose: The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was developed to predict the need for permanent CSF diversion in children with posterior fossa tumors (PFT). This study aimed to externally validate the mCPPRH in a cohort of 113 pediatric patients with PFTs., Methods: We conducted a retrospective analysis, calculating the mCPPRH score for each patient and performing receiver operating characteristic (ROC) curve analysis to assess the tool's discriminative ability. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using a cutoff score of ≥ 5. Multivariable logistic regression with bidirectional stepwise selection was used to evaluate individual components of the score. The mCPPRH components were modified and the performance of adjusted tools was compared to the original., Results: Of the 113 patients, 35 (31.0%) required permanent CSF diversion. The mCPPRH demonstrated acceptable discriminative ability (AUC = 0.701, 95% CI 0.608-0.795, p < 0.0003). Sensitivity was 34.1%, specificity 89.7%, positive predictive value 60%, and negative predictive value 75.3%. Initial regression identified no significant predictors. In stepwise regression, moderate-severe hydrocephalus independently predicted permanent CSF diversion (OR 6.37, 95% CI 1.71-41.55, p = 0.02). Increasing the age cutoff to < 5 years, removing tumor diagnosis, and modifying hydrocephalus weighting improved performance (AUC = 0.768, sensitivity 71.4%, specificity 75.6%)., Conclusions: The mCPPRH demonstrates acceptable discriminative ability (AUC 0.701) in our cohort, with particular utility in identifying low-risk patients. However, its poor sensitivity (34.1%) and variable predictor performance suggest that additional clinical factors should be considered for treatment planning, particularly in higher-risk cases. Further modification of mCPPRH components is suggested to improve its utility., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The Pediatric Emergency Care Applied Research Network (PECARN) derived and externally validated a clinical prediction rule to identify children with blunt torso trauma at low risk for intraabdominal injuries undergoing acute intervention (IAI AI ). Little is known about the risk for IAI AI when only one or two prediction rule variables are positive. We sought to determine the risk for IAI AI when either one or two PECARN intraabdominal injury rule variables are positive., Methods: We performed a planned secondary analysis of a prospective, multicenter study that included 7542 children (<18 years old) with blunt torso trauma evaluated in six emergency departments from December 2016 to August 2021. Patients with only one or two PECARN rule variables positive were included. The outcome was IAI AI (IAI undergoing therapeutic laparotomy, angiographic embolization, blood transfusion, or two or more nights of intravenous fluids)., Results: Among the 7542 children enrolled, 2986 (39.6%, 95% confidence interval [CI] 38.5%-40.7%) had one or two PECARN variables positive and were included. Of this subpopulation, 227 (7.6%, 95% CI 6.7%-8.6%) had intraabdominal injuries. In the 1639 patients with only one rule variable positive, 21 (1.3%, 95% CI 0.8%-2.0%) had IAI AI . In the 1347 patients with two rule variables positive, 27 (2.0%, 95% CI 1.3%-2.9%) had IAI AI . Risk for IAI AI for each variable was highest for Glasgow Coma Scale (GCS) score <14 (16/291, 5.5%, 95% CI 3.2%-8.8%) and abdominal wall trauma (three of 321, 0.9%, 95% CI 0.2%-2.7%). Risk for IAI AI when two variables were present was highest when decreased breath sounds (three of 44, 6.8%, 95% CI 1.4%-18.7%) and GCS <14 (10/207, 4.8%, 95% CI 2.3%-8.7%) were present with one other variable., Conclusions: Few children with blunt torso trauma and one or two PECARN predictor variables present have IAI AI . Those with GCS score <14, however, are at highest risk for IAI AI ., (© 2025 Society for Academic Emergency Medicine.)

AbstractBackground Recognising acute appendicitis in children presenting with acute abdominal pain in primary care is challenging. General practitioners (GPs) may benefit from a clinical prediction rule.Objectives To develop and validate a clinical prediction rule for acute appendicitis in children presenting with acute abdominal pain in primary care.Methods In a historical cohort study data was retrieved from GP electronic health records included in the Integrated Primary Care Information database. We assigned children aged 4–18 years presenting with acute abdominal pain (≤ 7 days) to development (2010–2012) and validation (2013–2016) cohorts, using acute appendicitis within six weeks as the outcome. Multiple logistic regression was used to develop a prediction model based on predictors with > 50% data availability derived from existing rules for secondary care. We performed internal and external temporal validation and derived a point score to stratify risk of appendicitis into three groups, i.e. low-risk, medium-risk and high-risk.Results The development and validation cohorts included 2,041 and 3,650 children, of whom 95 (4.6%) and 195 (5.3%) had acute appendicitis. The model included male sex, pain duration ( 48 h), nausea/vomiting, elevated temperature (≥ 37.3 °C), abnormal bowel sounds, right lower quadrant tenderness, and peritoneal irritation. Internal and temporal validation showed good discrimination (C-statistics: 0.93 and 0.90, respectively) and excellent calibration. In the three groups, the risks of acute appendicitis were 0.5%, 7.5%, and 41%,Conclusion Combined with further testing in the medium-risk group, the prediction rule could improve clinical decision making and outcomes.

الملخص: أهداف البحث: نظرا لانتشار متلازمة آلام الفخذ الرضفي والدور الفعال لتمارين التحكم القريبة ونقص الدراسات التي تعالج تنبؤات هذا التأثير، أجريت هذه الدراسة لفحص تأثير العمر، مؤشر كتلة الجسم، مدة الأعراض، وانحراف الركبة الداخلى الديناميكى على استجابة المرضى (الألم والوظيفة) لتمارين التحكم القريبة عند الإناث المصابات بمتلازمة آلام الفخذ الرضفي. طرق البحث: تم تجنيد خمسين أنثى مصابات بمتلازمة آلام الفخذ الرضفي من جامعة عين شمس بمتوسطعمر ٢٥ عاما، حصلوا على تمارين التحكم القريبة. تم عمل هذه التمارين مرتين أسبوعيا لمدة ٤ أسابيع. تم تقييم المرضى من أجل آلام الركبة عن طريق المقياس التناظري البصري، ووظيفة الركبة باستخدام استبانة كوجالا، وانحراف الركبة الداخلي الديناميكى باستخدام برنامج التحليل الحركى كينوفيا. تم حساب نسب الاحتمالية لتحديد عناصر الفحص التي كانت أكثر تنبؤًا بنتائج العلاج. حدد تحليل الانحدار اللوجستي للعناصر المدرجة في تحديد المتغيرات السريرية التي تتنبأ بالنجاح مع النتائج التي تحسن صنع القرار وكفاءة العلاج. النتائج: نجحت خمسة -وثلاثون (٧٠٪) من الإناث المصابات بـمتلازمة آلام الفخذ الرضفي ولقد تجاوز التحسن الحد الأدنى من الفرق المهم السريري (٫۱٫٨سم للألم و٨ نقاط للوظيفة) مع تمارين التحكم القريبة.من بين أربع تنبؤات تم اختبارها، يمكن أن تتنبأ مدة الأعراض (القيمة الاحتمالية = ٫٠۳٢) وانحراف الركبة الداخلي الديناميكي (القيمة الاحتمالية =٫٠٠٧) بالتحسن في آلام الركبة من خلال تمارين التحكم القريبة. ومع ذلك، فقط زاوية انحراف الركبة الداخلي الديناميكى التي مقدارها ≤ ٢۱٫٥ درجة لها منطقة مقبولة تحت المنحنى من حيث الحساسية، والنوعية ٫٧٢ ٠ و ٫٦ ٠ و ٫٦ ٠ على التوالي مع القيمة الاحتمالية = ٫٠۱٥ .واظهرت النتائج انه لا توجد مؤشرات على تحسن وظيفة الركبة. الاستنتاجات: مدة الأعراض وانحراف الركبة الداخلى الديناميكى من الممكن أن تتنبأ بالتحسن في متلازمة الألم الرضفي الفخذي بعد تمارين التحكم القريبة. Abstract: Objectives: Given the high prevalence of patellofemoral pain syndrome (PFPS) and the effectiveness of proximal control exercises, as well as the lack of studies addressing the predictors of this effect, we conducted this study to examine the effects of age, body mass index, symptom duration, and dynamic valgus of the knee on the pain and function responses to proximal control exercises in women with PFPS. Methods: Fifty women with PFPS with a mean age of 25 years, recruited from Ain Shams University, performed proximal control exercises twice weekly for 4 weeks. Knee pain was assessed with the visual analogue scale; knee function was assessed with the Kujala questionnaire; and dynamic knee valgus (DKV) was assessed through Kinovea Computer programmer video analysis. Likelihood ratios were calculated to determine the examination items most predictive of treatment outcomes. Logistic regression analysis identified items in the clinical prediction rule (identification of clinical variables predicting successful outcomes to improve decision-making and treatment efficacy). Results: Proximal control exercises resulted in successful improvement exceeding the minimal clinical important difference (1.8 cm for pain and 8 points for function) in 35 (70%) women with PFPS. Among the four tested predictors, symptom duration (P = 0.032) and DKV (P = 0.007) predicted amelioration of knee pain with proximal control exercises. However, the DKV angle ≥21.5° acceptable area under the curve, sensitivity, and specificity were 0.72, 0.6, and 0.6, respectively (P = 0.015). No predictors of improvement in knee function were identified. Conclusions: Symptom duration and DKV can predict amelioration of PFPS after proximal control exercises.

Objective: No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs. Patients and Methods: We conducted a retrospective cross‐sectional observational study of patients aged ≥60 years who were hospitalized for VCF at four hospitals in Japan in 2019–2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10‐m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut‐off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping. Results: Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut‐off of 45 points) were identified as significant predictors. We created a CPR using these two items (0–2 points). The CPR's AUC was 0.92 (0.874–0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965. Conclusion: The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut‐off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence. [ABSTRACT FROM AUTHOR]

Introduction Telephone triage is pivotal for evaluating the urgency of patient care, and in the Netherlands, the Netherlands Triage Standard (NTS) demonstrates moderate discrimination for chest pain. To address this, the Safety First Prediction Rule (SFPR) was developed to improve the safety of ruling out acute coronary syndrome (ACS) during telephone triage. Methods We conducted an external validation of the SFPR using data from the TRACE study, a retrospective cohort study in out-of-hours primary care. We evaluated the diagnostic accuracy assessment for ACS, major adverse cardiovascular events (MACE), and major events within 6 weeks. Moreover, we compared its performance with that of the NTS algorithm. Results Among 1404 included patients (57.3% female, 6.8% ACS, 8.6% MACE), the SFPR demonstrated good discrimination for ACS (C-statistic: 0.79; 95%-CI: 0.75–0.83) and MACE (C-statistic: 0.79; 95%-CI: 0.0.76–0.82). Calibration was satisfactory, with overestimation observed in high-risk patients for ACS. The SFPR (risk threshold 2.5%) trended toward higher sensitivity (95.8% vs. 86.3%) and negative predictive value (99.3% vs. 97.6%) with a lower negative likelihood ratio (0.10 vs. 0.34) than the NTS algorithm. Conclusion The SFPR proved robust for risk stratification in patients with acute chest pain seeking out-of-hours primary care in the Netherlands. Further prospective validation and implementation are warranted to refine and establish the rule's clinical utility. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy‐to‐use clinical prediction score for the diagnosis of IE in the ED. Methods and Results We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56–81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849–0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848–0.913) in the validation cohort, not significantly different from the one calculated in the retrospective cohort (P=0.578). Conclusions In this study, we propose and prospectively validate the CREED score, a clinical prediction rule for the diagnosis of IE in patients with fever admitted to the ED. Our data reflect the difficulty of creating a meaningful tool able to identify patients with IE among this general and heterogeneous population because of the complexity of the disease and its low prevalence in the ED setting.

Introduction and Aim:  Accurate determination of walking independence in older adults after hip fracture surgery is crucial for selecting appropriate walking strategies and providing fall prevention guidance. We developed and validated a clinical prediction rule (CPR) to determine level-surface walking independence and community walking independence in older adults with hip fractures., Methods: In a multicenter, cross-sectional study, we investigated 289 older inpatients with hip fractures. A backward stepwise logistic regression analysis was performed to develop a CPR for determining level-surface walking independence and community walking independence. The independent variables incorporated the patients' walking and balance evaluations at discharge, including the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and maximum walking speed (MWS), as well as age and cognitive function evaluations. We used a bootstrap internal validation for the CPR's internal validation., Results: At their hospital discharge, 171 patients had achieved level-surface walking independence, and 51 had achieved community walking independence. As the level of walking independence decreased, patients tended to be older, with lower BBS scores and slower TUG times and walking speeds. As diagnostic factors, the level-surface walking model included age, BBS, and cognitive decline; the community walking model included BBS, TUG, and MWS. The diagnostic accuracy, represented by the area under the curve (confidence interval), was 0.88 (0.84-0.92) for the level-surface walking model and 0.81 (0.74-0.87) for the community walking model. Internal validation confirmed that the models' discrimination accuracy was good, and no model overfitting was observed., Conclusions: We developed a moderately accurate CPR to determine walking independence in hip fracture patients. CPR can be a useful indicator for determining an individual's walking independence at present, but external validations with other samples are necessary., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Review Committees of Fujioka General Hospital, Public Nanokaichi Hospital, Hidaka Rehabilitation Hospital, and Hidaka Hospital issued approval #270, #20210100, #220402, #349. This study was conducted in compliance with the Declaration of Helsinki. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This study is supported by a Grant-in-Aid for Encouragement of Young Scientists from Ibaraki Prefectural University of Health Sciences. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Iwamura et al.)

Objective: Blepharospasm (BSP), focal dystonia with the highest risk of spread, lacks clear understanding of early spreading risk factors and objective prognostic indicators. We aimed to identify these risk factors through clinical and electrophysiological assessments, and to establish a predictive model for dystonic spread in BSP., Methods: We prospectively followed BSP patients for 4 years, collecting data on dystonic spread, and conducting electrophysiological evaluations. The blink reflex, masseter inhibitory reflex, and trigeminal somatosensory evoked potential were assessed. Univariable and multivariable Cox proportional hazard regression models were used to assess clinical characteristics associated with BSP dystonic spread. A predictive model was constructed using a nomogram, and performance of the model was evaluated using the area under the receiver operating characteristic curve., Results: A total of 136 enrolled participants (mean age 56.34 years) completed a 4-year follow-up. Among them, 62 patients (45.6%) showed spread to other body regions. Multivariable Cox regression analysis showed that a high Hamilton Anxiety Scale score (hazard ratio 1.19, 95% confidence interval 1.13-1.25, p < 0.001), prolonged trigeminal somatosensory evoked potential mandibular branch P1-N2 peak interval (hazard ratio 1.11, 95% confidence interval 1.02-1.21, p = 0.017), and elevated trigeminal somatosensory evoked potential mandibular branch P1-N2 peak amplitude (hazard ratio 1.26, 95% confidence interval 1.12-1.41, p < 0.001) were independent risk factors for BSP dystonic spread within 4 years. Combining these factors, the predictive models demonstrated excellent discriminative ability, with the receiver operating characteristic curve score being 0.797, 0.790, 0.847, and 0.820 at 1, 2, 3 and 4 years after enrollment, respectively., Interpretation: We established a predictive model with significant value for anticipating dystonic spread in BSP, offering crucial evidence. These findings contribute essential insights into the early clinical identification of the development and evolution of BSP diseases. ANN NEUROL 2024;96:747-757., (© 2024 American Neurological Association.)

Objectives We tested a previously developed clinical prediction tool—a nomogram consisting of four patient measures (lower patient-expected benefit, lower patient-reported knee function, greater knee varus angle and severe medial knee radiological degeneration) that were related to poor response to non-surgical management of knee osteoarthritis. This study sought to prospectively evaluate the predictive validity of this nomogram to identify patients most likely to respond poorly to non-surgical management of knee osteoarthritis.Design Multisite prospective longitudinal study.Setting Advanced practice physiotherapist-led multidisciplinary service across six tertiary hospitals.Participants Participants with knee osteoarthritis deemed appropriate for trial of non-surgical management following an initial assessment from an advanced practice physiotherapist were eligible for inclusion.Interventions Baseline clinical nomogram scores were collected before a trial of individualised non-surgical management commenced.Primary outcome measure Clinical outcome (Global Rating of Change) was collected 6 months following commencement of non-surgical management and dichotomised to responder (a little better to a very great deal better) or poor responder (almost the same to a very great deal worse). Clinical nomogram accuracy was evaluated from receiver operating characteristics curve analysis and area under the curve, and sensitivity/specificity and positive/negative likelihood ratios were calculated.Results A total of 242 participants enrolled. Follow-up scores were obtained from 210 participants (87% response rate). The clinical nomogram demonstrated an area under the curve of 0.70 (p