风险评估的风险:使用预测模型对治疗决策时的因果盲点
Nan van Geloven1, Ruth H Keogh2, Wouter van Amsterdam3
1Leiden University Medical Center, Leiden, the Netherlands (N.v.G., H.P.).
Annals of internal medicine
|July 28, 2025
概括
临床医生使用的预测模型可能包含"因果盲点",如果不仔细开发. 这可能导致对风险的误解,并可能通过告知错误的治疗决策来伤害患者.
科学领域:
- 生物统计学 生物统计学
- 临床流行病学临床流行病学
- 医疗信息学 医疗信息学
背景情况:
- 临床医生越来越多地使用预测模型作为治疗指导.
- 许多模型使用观察数据,包括已经接受治疗的患者,使解释复杂化.
- 因果推理对于准确的预测模型开发和应用至关重要.
研究的目的:
- 为了识别和说明.
- 造成的盲点是因果的盲点.
- 在常见的预测模型开发方法中.
- 倡导扩展的指导方针,确保准确的解释和应用预测模型.
主要方法:
- 分析常见的预测模型开发策略 (包括,限制,排除治疗).
- 插图使用现实世界的例子来展示误解风险.
- 讨论因果关系问题:混,选择,调解和时间变化的治疗方法.
主要成果:
- 预测模型中处理治疗的三种常见方法被发现具有"因果盲点".
- 误解模型衍生风险可能导致不理想的临床决策.
- 现有的方法可能无法充分考虑混,选择,调解和治疗变化.
结论:
- 针对治疗决策的预测模型需要"干预预测",需要因果推理.
- 对模型适用性,目标人群和治疗条件的明确沟通至关重要.
- 采用因果推断技术和更新的指导方针可以防止错误的决策和伤害患者.
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