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A Comparison of Clinical Judgment With a Prediction Rule

A. Lynne Brannen II, MD; Lisa J, Godfrey; William E. Goetter, MD

Arch Intern Med. 1989;149(5):1083-1086.

Abstract
• Quantitative methods to enhance clinical judgment would be of tremendous benefit to physicians caring for the critically ill. The ability of physicians to predict outcome is a logical standard on which to base the prospective evaluation of a prediction rule intended for this clinical use. The APACHE (acute physiology and chronic health evaluation)–II score was compared with critical care physicians' prediction of outcome for a group of patients in a medical intensive care unit. Physicians were significantly better in predicting outcome in the critically ill. However, the APACHE-II score was still a good predictor of outcome in the intensive care unit and, according to analysis using Bayes' theorem, might still be a useful test to support physicians' judgment, especially in patients with a predicted mortality risk of less than 30%.

(Arch Intern Med. 1989;149:1083-1086)

Author Affiliations
From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham. Dr Brannen is now with the Department of Medicine, Medical College of Georgia, Augusta.

Footnotes
Accepted for publication December 28, 1988.

Reprint requests to 3623 J. Dewey Gray Circle, Suite 100, Augusta, GA 30910 (Dr Brannen).

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