Clinical prediction rule

In a prediction rule study, investigators identify a consecutive group of patients who are suspected of having a specific disease or outcome. The investigators then obtain a standard set of clinical observations on each patient and a test or clinical follow-up to define the true state of the patient. They then use statistical methods to identify the best clinical predictors of the patient's true state. The probability of disease will depend on the patient's key clinical predictors. Published methodological standards specify good practices for developing a clinical prediction rule.{{Cite journal|last=Laupacis|first=Andreas|date=1997|title=Clinical prediction rules: a review and suggested modifications of methodological standards|journal=Journal of the American Medical Association|volume=297|pages=488–494|doi=10.1001/jama.1997.03540300056034}}

A survey of methods concluded "the majority of prediction studies in high impact journals do not follow current methodological recommendations, limiting their reliability and applicability",{{cite journal| vauthors=Bouwmeester W, Zuithoff NP, Mallett S, Geerlings MI, Vergouwe Y, Steyerberg EW| title=Reporting and methods in clinical prediction research: a systematic review. | journal=PLOS Med | year= 2012 | volume= 9 | issue= 5 | pages= e1001221 | pmid=22629234 | doi=10.1371/journal.pmed.1001221 | pmc= 3358324|display-authors=etal | doi-access=free }} confirming earlier findings from the diabetic literature.{{cite journal| vauthors=Collins GS, Mallett S, Omar O, Yu LM| title=Developing risk prediction models for type 2 diabetes: a systematic review of methodology and reporting. | journal=BMC Med | year= 2011 | volume= 9 | pages= 103 | pmid=21902820 | doi=10.1186/1741-7015-9-103 | pmc= 3180398 | doi-access=free }} The TRIPOD statement is now widely used to improve the quality of reporting of clinical prediction rules,Collins GS, Reitsma HB, Altman DG, Moons KGM. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): The TRIPOD Statement. Ann Intern Med. 2015;162:55-63 with an extension to provide guidance for clinical prediction rules developed using artificial intelligence methodsCollins GS, Moons KGM, Dhiman P, Riley RD, et al. TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ. 2024;385: e078378

Few prediction rules have had the consequences of their usage by physicians quantified.{{cite journal |vauthors=Reilly BM, Evans AT |title=Translating clinical research into clinical practice: impact of using prediction rules to make decisions |journal=Ann. Intern. Med. |volume=144 |issue=3 |pages=201–9 |year=2006 |pmid=16461965 |doi=10.7326/0003-4819-144-3-200602070-00009|s2cid=32179950 }}

When studied, the impact of providing the information alone (for example, providing the calculated probability of disease) has been negative.{{cite journal |vauthors=Lee TH, Pearson SD, Johnson PA |title=Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain |journal=Ann. Intern. Med. |volume=122 |issue=6 |pages=434–7 |year=1995 |pmid=7856992 |doi=10.7326/0003-4819-122-6-199503150-00006|s2cid=35487553 |display-authors=etal}}{{cite journal |vauthors=Poses RM, Cebul RD, Wigton RS |title=You can lead a horse to water--improving physicians' knowledge of probabilities may not affect their decisions |journal=Medical Decision Making |volume=15 |issue=1 |pages=65–75 |year=1995 |pmid=7898300 |doi=10.1177/0272989X9501500110|s2cid=72016252 }}

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.{{cite journal |vauthors=Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG |title=A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin |journal=JAMA |volume=283 |issue=6 |pages=749–55 |year=2000 |pmid=10683053 |doi=10.1001/jama.283.6.749|doi-access=free }}

The more intensively the prediction rule is implemented the more benefit will occur.{{cite journal |vauthors=Yealy DM, Auble TE, Stone RA |title=Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial |journal=Ann. Intern. Med. |volume=143 |issue=12 |pages=881–94 |year=2005 |pmid=16365469 |doi=10.7326/0003-4819-143-12-200512200-00006|s2cid=45414192 |display-authors=etal}}

• Apache II
• CHADS2 for risk of stroke with atrial fibrillation
• CURB-65
• Model for End-Stage Liver Disease
• Ranson criteria
• Centor criteria
• Pneumonia severity index
• Wells score (disambiguation)
• Orthopaedics
• Abbreviated Injury Scale
• Harris Hip Score
• Injury Severity Score
• Kocher criteria
• Mirel's Score
• NACA score
• Ottawa ankle rules
• Ottawa knee rules
• Pittsburgh knee rules
• Revised Trauma Score

{{reflist|30em}}

• [http://www.clinicalprediction.com/prediction-rules/ Clinical Prediction Website]
• [http://farmacologiaclinica.info Clinical prediction rules online calculators]

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Category:Health informatics

Category:Evidence-based medicine

Category:Medical scoring system