Pauker S G, Kassirer J P
Semin Nucl Med. 1978 Oct;8(4):324-35. doi: 10.1016/s0001-2998(78)80018-x.
The clinician must always optimize the patient's chance for the best possible outcome, but the complex task of deciding which diagnostic study to perform and which therapeutic agent to administer is usually carried out using imperfect information. These critical decisions are usually made in a covert fashion without explicit consideration of the multiple factors that impact on the outcome. Decision analysis is a quantitative method for making such diagnostic and therapeutic judgments, incorporating both probabilistic data and value judgments in the analysis of clinical problems. This article presents a brief overview of decision analysis and a detailed illustration of its use in an actual complex clinical situation. The clinical problem described consists of the management of suspected pulmonary embolism in a patient with a high risk of complications from both pulmonary arteriography and long-term anticoagulation. The example chosen also points up the virtue of decision analysis in considering prospectively both the information content and the attendant risks of contemplated diagnostic procedures.
临床医生必须始终优化患者获得最佳可能结果的机会，但决定进行何种诊断性检查以及使用何种治疗药物这一复杂任务，通常是在信息不完整的情况下进行的。这些关键决策通常是以隐蔽的方式做出的，并未明确考虑影响结果的多种因素。决策分析是一种用于做出此类诊断和治疗判断的定量方法，在临床问题分析中纳入了概率数据和价值判断。本文简要概述了决策分析，并详细说明了其在实际复杂临床情况中的应用。所描述的临床问题包括对一名因肺血管造影和长期抗凝治疗均有高并发症风险的疑似肺栓塞患者的管理。所选择的示例还凸显了决策分析在预先考虑拟实施的诊断程序的信息内容和伴随风险方面的优点。
