Watts C M, Knaus W A
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Crit Care Clin. 1994 Jan;10(1):73-89; discussion 91-2.
The acceptance and more widespread use of objective probability estimates will depend on addressing several practical issues. Physicians generally are unfamiliar with these estimates, their origin, and how they should be used. Physicians need to understand the conceptual origins of prognostic systems, their strengths and limitations, and their usefulness in helping to resolve uncertainty and improve critical decision making. Better communication and understanding of patient and family preferences and values will be necessary to ensure that the use of numerical predictions will not be the dominant or exclusive consideration. No matter how refined and elaborate these systems become, they represent simplification of even more complex biologic decision-making systems. The predictions must be interpreted carefully and used by trained intensivists, with the constant opportunity to exercise human discretion. The challenge to the developers of these systems will be to improve their accuracy, refine their use with specific disease entities that are important in determining outcome in critical care (e.g. multi-organ system failure, sepsis, adult respiratory distress syndrome), improve display of data and ease of data capture with automated systems, and construct data-bases and predictive equations that are fluid, constantly growing, and adjusting to capture developments in medical care.
客观概率估计的被接受程度及其更广泛的应用将取决于解决几个实际问题。医生通常不熟悉这些估计、其来源以及应如何使用它们。医生需要了解预后系统的概念起源、其优势和局限性，以及它们在帮助解决不确定性和改善关键决策方面的有用性。为确保数值预测的使用不会成为主要或唯一的考虑因素，更好地沟通和理解患者及家属的偏好和价值观将是必要的。无论这些系统变得多么精细和复杂，它们都代表着对更为复杂的生物决策系统的简化。预测必须由训练有素的重症监护医生仔细解读并使用，且始终要有行使人为判断力的机会。这些系统的开发者面临的挑战将是提高其准确性，针对在重症监护中对确定预后很重要的特定疾病实体（如多器官系统衰竭、脓毒症、成人呼吸窘迫综合征）优化其使用，通过自动化系统改善数据显示和数据采集的便捷性，并构建灵活、不断增长且能适应医疗护理发展的数据库和预测方程。
