Poses R M, Cebul R D, Collins M, Fager S S
JAMA. 1985 Aug 16;254(7):925-9.
Ten physicians recorded their treatment decisions and estimated probabilities of streptococcal infection for patients with sore throats. Of 308 throat cultures, 15 (4.9%) were positive for group A streptococci. The physicians overestimated the probability of a positive culture for 81% of their patients and their estimates and treatment decisions were strongly associated. Of 104 patients treated before culture results were available, only eight had positive cultures. Probability overestimation may have been due to neglect of the low culture-positive rate, assignment of undue importance to weakly predictive or highly intercorrelated clinical features, and a value-induced bias, occurring when features important for treatment are erroneously linked to the likelihood of disease. Cognitive limitations in information processing may limit the effectiveness of pharyngitis management protocols that require subjective estimates of disease probability.
十位医生记录了他们对咽喉痛患者的治疗决策，并估计了链球菌感染的概率。在308份咽喉培养样本中，15份（4.9%）A组链球菌呈阳性。医生对81%的患者培养阳性概率估计过高，且他们的估计与治疗决策密切相关。在104例在培养结果出来之前就接受治疗的患者中，只有8例培养结果呈阳性。概率估计过高可能是由于忽视了低培养阳性率、过度重视预测性弱或高度相互关联的临床特征，以及一种价值诱导偏差，即对治疗重要的特征被错误地与疾病可能性联系起来时产生的偏差。信息处理中的认知局限可能会限制需要主观估计疾病概率的咽炎管理方案的有效性。
