In their excellent Review Article on clinical prediction rules, Adams and Levenson (1) outline the concepts underlying development of quantitative clinical decision making and how databases and artificial intelligence can help a clinician. We would like to discuss two issues.
1. External validity of a clinical prediction rule should be a major concern. Testing of the rule in a separate population to see if it remains reliable may be disappointing (2). Subsequent updating of the model requires revalidation. Thus, clinicians need to be cautious when applying results to their practice. Patients should meet the inclusion criteria of the study which generated the predictive model (i.e the case mix) unless their estimation of the post test probability might be biased. Numerous factors external to the study may impact estimations . We propose studies elaborating clinical prediction rules apply to STARD statement (3). We would be interested to know authors' position.
2. Data quality is important for the development of the prediction rules (4). At an individual clinical level data quality is important for patients intended to be diagnosed or treated according to the prediction rule (there must be a sort of clinical GIGO rule). A thorough medical history and clinical examination performed by a scrupulous and experimented physician is probably what is required. High empathy could help. Something computers are not very good at.
References
1. Adams ST, Leveson SH. Clinical prediction rules. BMJ 2012;344:d8312
2. Toll DB, Janssen KJ, Vergouwe Y, Moons KG. Validation, updating and impact of clinical prediction rules: a review. J Clin Epidemiol. 2008;61:1085-94.
3. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D,Rennie D, de Vet HC, Lijmer JG; Standards for Reporting of Diagnostic Accuracy.The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138:W1-12.
4. Simel DL, Rennie D, Bossuyt PM. The STARD statement for reporting diagnostic accuracy studies: application to the history and physical examination. J Gen ntern Med. 2008;23:768-74
Competing interests:
No competing interests
19 February 2012
Olivier Nardi
MD, MPH
Anne-Valérie Gainet, MD Clinique de Goussonville 78930 Goussonville, France
Rapid Response:
Re: Clinical prediction rules
In their excellent Review Article on clinical prediction rules, Adams and Levenson (1) outline the concepts underlying development of quantitative clinical decision making and how databases and artificial intelligence can help a clinician. We would like to discuss two issues.
1. External validity of a clinical prediction rule should be a major concern. Testing of the rule in a separate population to see if it remains reliable may be disappointing (2). Subsequent updating of the model requires revalidation. Thus, clinicians need to be cautious when applying results to their practice. Patients should meet the inclusion criteria of the study which generated the predictive model (i.e the case mix) unless their estimation of the post test probability might be biased. Numerous factors external to the study may impact estimations . We propose studies elaborating clinical prediction rules apply to STARD statement (3). We would be interested to know authors' position.
2. Data quality is important for the development of the prediction rules (4). At an individual clinical level data quality is important for patients intended to be diagnosed or treated according to the prediction rule (there must be a sort of clinical GIGO rule). A thorough medical history and clinical examination performed by a scrupulous and experimented physician is probably what is required. High empathy could help. Something computers are not very good at.
References
1. Adams ST, Leveson SH. Clinical prediction rules. BMJ 2012;344:d8312
2. Toll DB, Janssen KJ, Vergouwe Y, Moons KG. Validation, updating and impact of clinical prediction rules: a review. J Clin Epidemiol. 2008;61:1085-94.
3. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D,Rennie D, de Vet HC, Lijmer JG; Standards for Reporting of Diagnostic Accuracy.The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138:W1-12.
4. Simel DL, Rennie D, Bossuyt PM. The STARD statement for reporting diagnostic accuracy studies: application to the history and physical examination. J Gen ntern Med. 2008;23:768-74
Competing interests: No competing interests