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Published on: March 4, 2018
Clinical judgment is a cornerstone for validating and using clinical prediction rules: a head-to-head study on
Rémi Pelletier-Roy1,2, Andréane Richard-Denis1,2, Stéphanie Jean1,3
1Université de Montréal, Faculty of Medicine, Montréal, QC, Canada.
Study Design:
Retrospective comparative study.
Objective:
Clinical prediction rules (CPRs) are an effervescent topic in the medical literature. Recovering ambulation after a traumatic spinal cord injury (tSCI) is a priority for patients and multiple CPRs have been proposed for predicting ambulation outcomes. Our objective is to confront clinical judgment to an established CPR developed for patients with tSCI.
Settings:
Level one trauma center specialized in tSCI and its affiliated rehabilitation center.
Method:
In this retrospective comparative study, six physicians had to predict the ambulation outcome of 68 patients after a tSCI based on information from the acute hospitalization. Ambulation was also predicted according to the CPR of van Middendorp (CPR-vM). The success rate of the CPR-vM and clinicians to predict ambulation was compared using criteria of 5% for defining clinical significance, and a level of statistical significance of 0.05 for bilateral McNemar tests.
Results:
There was no statistical difference between the overall performance of physicians (success rate of 79%) and of the CPR-vM (81%) for predicting ambulation. The differences between the CPR-vM and physicians varied clinically and significantly with the level of experience, clinical setting, and field of expertise.
Conclusion:
Confronting CPRs with the judgment of a group of clinicians should be an integral part of the design and validation of CPRs. Head-to-head comparison of CPRs with clinicians is also a cornerstone for defining the optimal strategy for translation into the clinical practice, and for defining which clinician and specific clinical context would benefit from using the CPR.
