重症监护病房预后模型中的反循环:对临床有效性的未被认可的威胁
Daniel R Balcarcel1, Sanjiv D Mehta1, Celeste G Dixon1
1Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
The Lancet. Digital health
|July 22, 2025
概括
在重症监护室 (ICU) 的预后模型往往无法改善患者的治疗结果,原因是忽略了治疗效应. 对模型介导干预和因果关系的考虑对于准确的预后模型和更好的患者护理至关重要.
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
- 医疗保健服务研究 医疗服务研究
背景情况:
- 预后模型对于重症监护室 (ICU) 的决策和患者护理至关重要.
- 由于开发和验证的局限性,现有的模型往往无法改善以患者为中心的结果.
- 治疗干预措施对患者结果的影响在模型创建过程中经常被忽视.
研究的目的:
- 突出在预后模型开发中忽视治疗干预效应的关键限制.
- 为了解释由模型和临床干预之间的反循环引起的"模型漂移"现象.
- 提出一个框架,用于开发更有效的预后模型在ICU.
主要方法:
- 在ICU实施预后模型的概念分析.
- 检查反循环和预测,干预和结果之间的因果关系.
- 审查当前预后模型验证的局限性.
主要成果:
- 预后模型可以通过模型介导干预无意中改变患者的结果,导致"模型漂移".
- 积极的反循环可以创造自我实现的预言,而负面的反循环可以掩盖干预的有效性.
- 当前的模型往往无法解释这些动态相互作用,限制了它们的临床实用性.
结论:
- 对于ICU的预后模型必须纳入治疗效应和因果途径,以确保准确性和有效性.
- 数据科学家,流行病学家,临床医生和实施科学家之间的合作是至关重要的.
- 解决模型漂移是开发预后工具的关键,这些工具可以真正提高患者护理并防止伤害.
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