Clinical prediction rule
Encyclopedia
A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign
, symptoms, and other findings in predicting the probability of a specific disease or outcome.
Physicians have difficulty in estimated risks of diseases; frequently erring towards overestimation, perhaps due to cognitive biases such as base rate fallacy
in which the risk of an adverse outcome is exaggerated.
.
When studied, the impact of providing the information alone (for example, providing the calculated probability of disease) has been negative.
However, when the prediction rule is implemented as part of a critical pathway, so that a hospital or clinic has procedures and policies established for how to manage patients identified as high or low risk of disease, the prediction rule has more impact on clinical outcomes.
The more intensively the prediction rule is implemented the more benefit will occur.
Medical sign
A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....
, symptoms, and other findings in predicting the probability of a specific disease or outcome.
Physicians have difficulty in estimated risks of diseases; frequently erring towards overestimation, perhaps due to cognitive biases such as base rate fallacy
Base rate fallacy
The base rate fallacy, also called base rate neglect or base rate bias, is an error that occurs when the conditional probability of some hypothesis H given some evidence E is assessed without taking into account the "base rate" or "prior probability" of H and the total probability of evidence...
in which the risk of an adverse outcome is exaggerated.
Methods
In a prediction rule study, investigators identify a consecutive group of patients who are suspected of a having a specific disease or outcome. The investigators then compare the value of clinical findings available to the physician versus the results of more intensive testing or the results of delayed clinical follow up. It may involve, among other things, estimation of the clinical utility of diagnostic testsClinical utility of diagnostic tests
The clinical utility of a diagnostic test is its capacity to rule diagnosis in and/or out and to make a decision possible to adopt or to reject a therapeutic action. It can be integrated into clinical prediction rules for specific diseases or outcomes....
.
Effect on health outcomes
Few prediction rules have had the consequences of their usage by physicians quantified.When studied, the impact of providing the information alone (for example, providing the calculated probability of disease) has been negative.
However, when the prediction rule is implemented as part of a critical pathway, so that a hospital or clinic has procedures and policies established for how to manage patients identified as high or low risk of disease, the prediction rule has more impact on clinical outcomes.
The more intensively the prediction rule is implemented the more benefit will occur.
Examples of prediction rules
- Apache IIAPACHE IIAPACHE II is a severity-of-disease classification system , one of several ICU scoring systems...
- CHADS2 for risk of stroke with AFIB
- CURB-65
- Model for End-Stage Liver DiseaseModel for End-Stage Liver DiseaseThe Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict death within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt procedure, and was...
- Ranson criteria
- Pneumonia severity indexPneumonia severity indexThe pneumonia severity index [PSI] or PORT Score is a clinical prediction rule that medical practitioners can use to calculate the probability of morbidity and mortality among patients with community acquired pneumonia....
- Wells score (disambiguation)Wells score (disambiguation)The Wells Score may refer to one of two clinical prediction rules in clinical medicine.* DVT probability scoring for diagnosing deep vein thrombosis* Pulmonary embolism probability scoring for diagnosing pulmonary embolism...
- Ottawa ankle rulesOttawa ankle rulesIn medicine, the Ottawa ankle rules are a set of guidelines for doctors to aid them in deciding if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Before the introduction of the rules most patients with ankle injuries would have been X-rayed...
- Pittsburgh knee rulesPittsburgh knee rulesThe Pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires the use of X-ray to assess a fracture.- Criteria :* Blunt trauma or a fall as mechanism of injury AND either of the following...