PREDICTING OUTCOME IN CORONARY-DISEASE - STATISTICAL-MODELS VERSUS EXPERT CLINICIAN
PREDICTING OUTCOME IN CORONARY-DISEASE - STATISTICAL-MODELS VERSUS EXPERT CLINICIAN
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DOI：
10.1016/0002-9343(86)90807-7
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发表时间：
1986-04-01
影响因子：
5.9
通讯作者：
ROSATI, RA
中科院分区：
文献类型：
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作者：
LEE, KL;PRYOR, DB;ROSATI, RA
为了研究预测冠状动脉疾病患者长期预后的准确性，对基于数据的多变量统计模型的预后预测与资深临床心脏病专家的预测进行了比较。每名患者的测试样本是从大量接受药物治疗的严重冠状动脉疾病患者中挑选出来的。使用详细的病例摘要，五名资深心脏病专家每人预测了100名患者的一年和三年生存以及无梗死生存概率。50名患者出现在多个样本中，用于评估医生间的可变性。使用不在测试样本中的患者开发的COX回归模型预测了每个测试患者的相应结果概率。总体而言，模型预测与实际患者结果的相关性比医生的预测更好。三年生存率的等级相关系数分别为0.61(模型)和0.49(医生)。对于三年无梗死存活预测，与预后的相关性分别为0.48(模型)和0.29(医生)。个别医生的比较显示，COX模型对三年生存率的预测比五个医生中的四个更好(模型预测为医生S的预测增加了重要的预后信息，而反过来则不是)。对于无梗死生存，COX模型优于所有五个医生。当预测是由多个医生做出的时候，医生间的差异很大。在冠状动脉疾病中，从仔细收集的数据建立的统计模型可以提供比经验丰富的临床医生通过详细的病例总结做出的预测更准确的预后预测。
To study the accuracy with which long-term prognosis can be predicted in patients with coronary artery disease, prognostic predictions from a data-based multivariable statistical model were compared with predictions from senior clinical cardiologists. Test samples of 100 patient each were selected from a large series of medically treated patients with significant coronary disease. Using detailed case summaries, five senior cardiologists each predicted one- and three-year survival and infarct-free survival probabilities for 100 patients. Fifty patients appeared in multiple samples for assessing interphysician variability. Cox regression models, developed using patients not in the test samples, predicted corresponding outcome probabilities for each test patient. Overall, model predictions correlated better with actual patient outcomes than did the doctors'' predictions. For three-year survival, rank correlations were 0.61 (model) and 0.49 (doctors). For three-year infarct-free survival predictions, correlations with outcome were 0.48 (model) and 0.29 (doctors). Comparisons by individual doctor revealed Cox model three-year survival predictions were better than those of four of five doctors (model predictions added significant [p < 0.05] prognostic information to the doctor''s predictions, whereas the converse was not true). For infarct-free survival, the Cox model was superior to all five doctors. Where predictions were made by multiple doctors, the interphysician variability was substantial. In coronary artery disease, statistical models developed from carefully collected data can provide prognostic predictions that are more accurate than predictions of experienced clinicians made from detailed case summaries.