Gilpin E A, Olshen R A, Chatterjee K, Kjekshus J, Moss A J, Henning H, Engler R, Blacky A R, Dittrich H, Ross J
Division of Cardiology, University of California, San Diego, La Jolla 92093.
Comput Biomed Res. 1990 Feb;23(1):46-63. doi: 10.1016/0010-4809(90)90006-x.
Whether decision rules derived statistically from patient data can produce better decisions than an expert clinician or a model of the expert clinician (expert system) is controversial. We examined this issue in the context of predicting cardiac death by 1 year for patients discharged from the hospital following acute myocardial infarction. Decision rules were derived from a base sample of 781 patients. These decision rules and three experienced cardiologists then estimated probability of death by 1 year for each patient in a separate test sample (n = 400). In our evaluation of the performance of the decision rules and physicians, we detected no differences, although the decision rules and physicians tended to classify the patients somewhat differently. Further multivariate analyses on the physicians' predictions showed that two of the physicians paid attention to somewhat different variables than the third physician. Lack of agreement among expert cardiologists would complicate modeling of a consensual decision-making process within the framework of an expert system.
从患者数据中通过统计得出的决策规则是否能比专家临床医生或专家临床医生模型（专家系统）做出更好的决策，这是存在争议的。我们在预测急性心肌梗死后出院患者1年内心脏死亡的背景下研究了这个问题。决策规则来自781名患者的基础样本。然后，这些决策规则和三位经验丰富的心脏病专家对另一个独立测试样本（n = 400）中的每位患者估计了1年内的死亡概率。在我们对决策规则和医生表现的评估中，我们没有发现差异，尽管决策规则和医生对患者的分类方式略有不同。对医生预测的进一步多变量分析表明，其中两位医生关注的变量与第三位医生有所不同。专家心脏病专家之间缺乏一致性会使在专家系统框架内构建共识决策过程的模型变得复杂。
