This month’s CJEM Infographic summarizes the PERIL Rule – a clinical decision instrument designed to help paramedics to identify patients who are at risk for adverse events [cite num=”1″]. The summarized study was published in the most recent version of the Canadian Journal of Emergency Medicine.
Featured in the latest CanadiEM infographic, this study by Lee et al1 set out to develop a clinical prediction rule to help paramedics identify high risk older adults. The methodology involved identifying 43 predictor variables in three systemic reviews.2–4 The authors defined the composite endpoint as a repeat visit to the ED, hospitalization, and/or death within 30 days of the EMS encounter. Paramedics were trained to use this checklist to assess patients >65 years old in their home after responding to a 911 call. Four significant independent predictors associated with the primary outcome measure were isolated.
The four-item PERIL rule was derived and performed better than clinical judgement (AUC 0.62 vs. 0.56, p=0.02). Adherence for the PERIL rule was also higher than the alternate Identifying Seniors at Risk (ISAR) tool. Of note however, the ISAR tool has been found only to have poor to fair validity5 related to revisiting the ED and hospital readmission.
This study aimed to provide a new tool for paramedics to use to help identify high risk older adults. The result was a simple, easy to use prediction rule with high adherence rate that has possible future use following further validation.