Ivanov J, Borger M A, David T E, Cohen G, Walton N, Naylor C D
Division of Cardiovascular Surgery, the Toronto General Hospital and University of Toronto, Ontario, Canada.
Ann Thorac Surg. 2000 Jul;70(1):162-8. doi: 10.1016/s0003-4975(00)01387-4.
The purpose of this study was to compare clinicians' prior probability estimates of operative mortality (OM) and prolonged intensive care unit stay (ICU) length of stay greater than 48 hours after coronary artery bypass graft surgery (CABG) with estimates derived from statistical models alone.
Nine clinicians estimated the predicted probability of OM and ICU stay greater than 48 hours from an abstract of information for each of 100 patients selected from the 1996 to 1997 database of 1,904 patients who underwent isolated CABG. Logistic regression models were used to calculate the predicted probability of OM and ICU stay greater than 48 hours for each patient. The study sample was split into two parts; clinicians were randomly given access to a predictive rule to guide their judgements for one part of the study.
Clinicians' estimates were similar with or without access to the rule, and both parts of the study were therefore pooled. Clinicians significantly overestimated the probability of OM (model 6.3% +/- 1%, clinicians 7.6% +/- 3%, p = 0.0001) and ICU stay greater than 48 hours (model 25% +/- 2%, clinicians 28% +/- 1%, p = 0.0012). Clinicians' estimates of OM were not significantly higher than the model's for nonsurvivors (0.8% +/- 0.7%, p = 0.2), but were significantly higher for survivors (1.4% +/- 0.3%, p = 0.039).
Clinicians trusted their own empiric estimates rather than a predictive rule and overestimated the probability of OM and ICU stay greater than 48 hours.
本研究的目的是比较临床医生对冠状动脉搭桥手术（CABG）后手术死亡率（OM）和重症监护病房（ICU）延长住院时间超过48小时的先验概率估计与仅从统计模型得出的估计值。
9名临床医生根据从1996年至1997年1904例接受单纯CABG手术患者的数据库中选出的100例患者的信息摘要，估计OM和ICU住院时间超过48小时的预测概率。使用逻辑回归模型计算每名患者OM和ICU住院时间超过48小时的预测概率。研究样本分为两部分；临床医生被随机给予一个预测规则以指导他们对研究的一部分进行判断。
无论是否使用该规则，临床医生的估计值都相似，因此研究的两部分合并。临床医生显著高估了OM的概率（模型为6.3%±1%，临床医生为7.6%±3%，p = 0.0001）以及ICU住院时间超过48小时的概率（模型为25%±2%，临床医生为28%±1%，p = 0.0012）。临床医生对非幸存者的OM估计值不显著高于模型（0.8%±0.7%，p = 0.2），但对幸存者的估计值显著更高（1.4%±0.3%，p = 0.039）。
临床医生信任他们自己的经验估计而非预测规则，并且高估了OM和ICU住院时间超过48小时的概率。
