Clinical prediction rule

Short description: Rule about how to use medical findings to estimate the probability of a clinical condition

A clinical prediction rule or clinical probability assessment specifies how to use medical signs, symptoms, and other findings to estimate the probability of a specific disease or clinical outcome.[1]

Physicians have difficulty in estimated risks of diseases; frequently erring towards overestimation,[2] perhaps due to cognitive biases such as base rate fallacy in which the risk of an adverse outcome is exaggerated.

## Contents

* 1 Methods
* 2 Effect on health outcomes
* 3 Examples of prediction rules
* 4 References
* 5 External links

## Methods

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.[3]

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",[4] confirming earlier findings from the diabetic literature.[5] The TRIPOD statement is now widely used to improve the quality of reporting of clinical prediction rules,[6] with an extension to provide guidance for clinical prediction rules developed using artificial intelligence methods[7]

## Effect on health outcomes

Few prediction rules have had the consequences of their usage by physicians quantified.[8]

When studied, the impact of providing the information alone (for example, providing the calculated probability of disease) has been negative.[9][10]

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.[11]

The more intensively the prediction rule is implemented the more benefit will occur.[12]

## Examples of prediction rules

* 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)
* 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

## References

1. ↑ "Users' guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group". JAMA 284 (1): 79–84. 2000. doi:10.1001/jama.284.1.79. PMID 10872017.
2. ↑ "Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease". Ann. Intern. Med. 124 (4): 414–21. 1996. doi:10.7326/0003-4819-124-4-199602150-00005. PMID 8554250.
3. ↑ Laupacis, Andreas (1997). "Clinical prediction rules: a review and suggested modifications of methodological standards". Journal of the American Medical Association 297: 488–494. doi:10.1001/jama.1997.03540300056034.
4. ↑ "Reporting and methods in clinical prediction research: a systematic review.". PLOS Med 9 (5). 2012. doi:10.1371/journal.pmed.1001221. PMID 22629234.
5. ↑ "Developing risk prediction models for type 2 diabetes: a systematic review of methodology and reporting.". BMC Med 9: 103. 2011. doi:10.1186/1741-7015-9-103. PMID 21902820.
6. ↑ 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
7. ↑ Collins 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
8. ↑ "Translating clinical research into clinical practice: impact of using prediction rules to make decisions". Ann. Intern. Med. 144 (3): 201–9. 2006. doi:10.7326/0003-4819-144-3-200602070-00009. PMID 16461965.
9. ↑ "Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain". Ann. Intern. Med. 122 (6): 434–7. 1995. doi:10.7326/0003-4819-122-6-199503150-00006. PMID 7856992.
10. ↑ "You can lead a horse to water--improving physicians' knowledge of probabilities may not affect their decisions". Medical Decision Making 15 (1): 65–75. 1995. doi:10.1177/0272989X9501500110. PMID 7898300.
11. ↑ "A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin". JAMA 283 (6): 749–55. 2000. doi:10.1001/jama.283.6.749. PMID 10683053.
12. ↑ "Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial". Ann. Intern. Med. 143 (12): 881–94. 2005. doi:10.7326/0003-4819-143-12-200512200-00006. PMID 16365469.

## External links

* Clinical Prediction Website
* Clinical prediction rules online calculators

* v
* t
* e

Tests, surgery and other procedures involving the respiratory system (ICD-9-CM V3 21–22, 30–34, ICD-10-PCS 0B)

Upper RT|

nose

Rhinoplasty
Septoplasty
Somnoplasty
Alarplasty
Rhinectomy
Rhinomanometry
Acoustic rhinometry

sinus

Sinusotomy

larynx

Laryngoscopy
Laryngectomy
Laryngotomy

Thyrotomy
Laryngotracheal reconstruction

Lower RT|

trachea

Cricothyrotomy
Tracheoesophageal puncture
Tracheotomy

bronchus

Bronchoscopy

lung

Pneumonectomy
Lobectomy
Wedge resection
Lung transplantation
Decortication of lung
Heart–lung transplant

Chest wall, pleura,
mediastinum,
and diaphragm|

pleura/pleural cavity

Thoracentesis
Pleurodesis
Thoracoscopy
Thoracotomy
Chest tube

mediastinum

Mediastinoscopy

Nuss procedure

Medical imaging|

* Bronchography
* CT pulmonary angiogram
* High-resolution computed tomography
* Spiral CT
* Ventilation/perfusion scan

CPRs|

* Pneumonia severity index
* CURB-65

Lung function test|

* Body plethysmography
* Spirometry
* Bronchial challenge test
* Capnography
* Diffusion capacity

Cytology|

* Sputum culture
* Bronchoalveolar lavage

Respiratory therapy/
intubation|

* Artificial respiration
* CPR
* Hyperbaric medicine
* Decompression chamber
* Heliox
* Mechanical ventilation
* Nebulizer
* Negative pressure ventilator
* Oxygen therapy
* Positive pressure ventilation
* Postural drainage
* Surgical airway management

* v
* t
* e

Orthopedic surgery, operations/surgeries and other procedures on bones and joints (ICD-9-CM V3 76–81, ICD-10-PCS 0P–S)

Bones|

| Facial|

* Jaw reduction
* Dentofacial osteotomy
* Genioplasty/Mentoplasty
* Chin augmentation
* Orthognathic surgery

|

Spine|

* Coccygectomy
* Laminotomy
* Laminectomy
* Laminoplasty
* Corpectomy
* Facetectomy
* Foraminotomy
* Vertebral fixation
* Percutaneous vertebroplasty

Upper extremity|

* Acromioplasty

Lower extremity|

* Femoral head ostectomy
* Astragalectomy
* Distraction osteogenesis
* Ilizarov apparatus
* Phemister graft

General|

* Ostectomy
* Bone grafting
* Osteotomy
* Epiphysiodesis
* Reduction
* Internal fixation
* External fixation
* Tension band wiring

Cartilage|

* Articular cartilage repair
* Microfracture surgery
* Knee cartilage replacement therapy
* Autologous chondrocyte implantation

Joints|

| Spine|

* Arthrodesis
* Spinal fusion
* Intervertebral discs
* Discectomy
* Annuloplasty
* Arthroplasty

|

Upper extremity|

* Shoulder surgery
* Shoulder replacement
* Bankart repair
* Weaver–Dunn procedure
* Ulnar collateral ligament reconstruction
* Hand surgery
* Brunelli procedure
* Finger joint replacement

Lower extremity|

* Hip resurfacing
* Hip replacement
* Rotationplasty
* Anterior cruciate ligament reconstruction
* Knee replacement/Unicompartmental knee arthroplasty
* Ankle replacement
* Broström procedure
* Triple arthrodesis

General|

* Arthrotomy
* Arthroplasty
* Synovectomy
* Arthroscopy
* Replacement joint
* imaging: Arthrogram
* Arthrocentesis

* v
* t
* e

Surgical procedures involving the digestive system (ICD-9-CM V3 42–54, ICD-10-PCS 0D)

Digestive tract|

| Upper GI tract|

| SGs / Esophagus|

* Esophagectomy
* Heller myotomy
* Sialography
* Impedance–pH monitoring
* Esophageal pH monitoring
* Esophageal motility study

|

Stomach|

* Bariatric surgery
* Adjustable gastric band
* Endoscopic sleeve gastroplasty
* Gastric bypass surgery
* Sleeve gastrectomy
* Vertical banded gastroplasty surgery
* Collis gastroplasty
* Gastrectomy
* Billroth I
* Billroth II
* Roux-en-Y
* Gastroenterostomy
* Gastropexy
* Gastrostomy
* Percutaneous endoscopic gastrostomy
* Esophagogastric dissociation
* Hill repair
* Nissen fundoplication
* Pyloromyotomy

Medical imaging|

* Endoscopy: Esophagogastroduodenoscopy
* Barium swallow
* Upper gastrointestinal series

Lower GI tract|

| Small bowel|

* Bariatric surgery
* Duodenal switch
* Jejunoileal bypass
* Bowel resection
* Ileostomy
* Intestine transplantation
* Jejunostomy
* Partial ileal bypass surgery
* Strictureplasty

|

Large bowel|

* Appendicectomy
* Colectomy
* Colonic polypectomy
* Colostomy
* Hartmann's operation

Rectum|

* Abdominoperineal resection / Miles operation
* Lower anterior resection
* Total mesorectal excision

Anal canal|

* Anal sphincterotomy
* Anorectal manometry
* Lateral internal sphincterotomy
* Rubber band ligation
* Transanal hemorrhoidal dearterialization

Medical imaging|

* Endoscopy: Colonoscopy
* Anoscopy
* Capsule endoscopy
* Enteroscopy
* Proctoscopy
* Sigmoidoscopy

* Abdominal ultrasonography
* Defecography
* Double-contrast barium enema
* Endoanal ultrasound
* Enteroclysis
* Lower gastrointestinal series
* Small-bowel follow-through
* Transrectal ultrasonography
* Virtual colonoscopy

Stool tests|

* Fecal fat test
* Fecal pH test
* Stool guaiac test

Accessory|

| Liver|

* Artificial extracorporeal liver support
* Bioartificial liver devices
* Liver dialysis
* Hepatectomy
* Liver biopsy
* Liver transplantation
* Portal hypertension
* Transjugular intrahepatic portosystemic shunt [TIPS]
* Distal splenorenal shunt procedure

|

Gallbladder, bile duct|

* Cholecystectomy
* Cholecystostomy
* ERCP
* Hepatoportoenterostomy

* Medical imaging: Cholangiography
* IV
* MRCP
* PTC
* Cholecystography
* Cholescintigraphy

Pancreas|

* Frey's procedure
* Pancreas transplantation
* Pancreatectomy
* Pancreaticoduodenectomy
* Puestow procedure

Abdominopelvic|

| Peritoneum|

* Diagnostic peritoneal lavage
* Intraperitoneal injection
* Laparoscopy
* Omentopexy
* Paracentesis
* Peritoneal dialysis

|

Hernia|

* Hernia repair: Inguinal hernia surgery
* Femoral hernia repair

Other|

* Laparotomy
* Exploratory laparotomy
* Rapid urease test / Urea breath test

CPRs|

* MELD
* PELD
* UKELD
* Child–Pugh score
* Ranson criteria
* Milan criteria

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