与预后临床预测模型相比,临床判断显示了类似的,有时甚至更高的歧视. 一个系统的审查
Luis Enrique Colunga-Lozano1, Farid Foroutan2, Daniel Rayner2
1Department of clinical medicine, Health science center, Universidad de Guadalajara, Guadalajara, Jalisco, México; Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.
Journal of clinical epidemiology
|November 4, 2024
概括
临床医生的判断往往与临床预测模型的预测准确度相匹配或超过,尽管模型提供了更好的校准. 需要进一步的研究来改善这些比较的报告标准.
科学领域:
- 医疗信息学 医疗信息学
- 临床流行病学临床流行病学
- 生物统计学 生物统计学
背景情况:
- 临床预测模型 (CPM) 和临床医生判断 (CJ) 对患者预后至关重要.
- 在临床决策中,CPM和CJ之间的比较性能数据是必不可少的.
研究的目的:
- 系统地审查和比较预后性CPM与CJ的统计性能.
- 评估两种方法的歧视和校准能力.
主要方法:
- 来自主要数据库 (PubMed,Medline,Embase,CINAHL) 的观察性研究的系统审查.
- 包括直接比较预后CPM和CJ的研究.
- 使用PROBAST工具进行偏差风险评估.
主要成果:
- 审查了41项研究,其中大多数显示有偏差的高风险.
- 对CPM的中位数AUC为0.73与CJ的0.71;46.7%显示没有显著差异的歧视.
- 在校准 (4项研究) 中,CPM的表现优于CJ,而在许多情况下,歧视是可比的或有利于CJ.
结论:
- 临床医师的判断经常显示出与预后CPM相比的或更高的歧视.
- 预测性CPM显示了比临床医生的判断更好的校准性能.
- 对比性绩效评估的研究报告需要显著改进.
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