Clinical Sensibility and Barriers to Knowledge Translation

TO THE EDITOR:

Reilly and Evans (1) have provided a very useful discussion of how to study the impact of clinical prediction and decision rules in actual practice. Most rules of this type have not received such evaluations; it is hoped that this work will encourage researchers to begin to fill in this gap. We have 3 specific comments about the article.

First, the authors' introduction states, “How frequently these and other prediction rules are being used in clinical practice is not known.” This is certainly true of the vast majority of rules, but a fair bit is now known about the rules developed in Ottawa (2-5). Surveys of nationally representative samples of Canadian emergency physicians have shown that the Ottawa Ankle Rule is known to virtually all and is reportedly used by almost 90% of Canadian emergency physicians (2, 4), whereas international surveys show …