THE THRESHOLD APPROACH TO CLINICAL DECISION-MAKING
THE THRESHOLD APPROACH TO CLINICAL DECISION-MAKING
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DOI：
10.1056/nejm198005153022003
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发表时间：
1980-01-01
影响因子：
158.5
通讯作者：
KASSIRER, JP
中科院分区：
文献类型：
--
作者：
PAUKER, SG;KASSIRER, JP
医生S对患者罹患某种疾病的概率的估计是决定是暂停治疗、通过检测获得更多数据还是在不使患者面临进一步诊断测试的风险的情况下进行治疗的主要因素。利用决策分析的概念，推导出了这一选择所涉及的两个阈值概率的表达式：测试阈值和测试处理阈值。可以从有关诊断测试的可靠性和潜在风险以及特定治疗的益处和风险的数据中为这些阈值赋值。如果患病概率小于检测阈值，则应停止治疗；如果患病概率大于检测-治疗阈值，则应在不进行进一步检测的情况下进行治疗。只有当患病概率在两个阈值之间时，才应进行检测(根据检测结果进行治疗)。该方法揭示了决策的重要原则，并帮助临床医生开发一种合理的、定量的方法来使用诊断测试。
The physician''s estimate of the probability that a patient has a particular disease is a principal factor in the determination of whether to withhold treatment, obtain more data by testing, or treat without subjecting the patient to the risks of further diagnostic tests. Using the concepts of decision analysis, expressions were derived for two threshold probabilities involved in this choice: a testing threshold and a test-treatment threshold. Values can be assigned to these thresholds from data on the reliability and potential risks of the diagnostic test and the benefits and risks of a specific treatment. Treatment should be withheld if the probability of disease is smaller than the testing threshold and treatment should be given without further testing if the probability of disease is greater than the test-treatment threshold. The test should be performed (with treatment depending on the test outcome) only if the probability of disease is between the two thresholds. The method exposes important principles of decision making and helps the clinician develop a rational, quantitative approach to the use of diagnostic tests.