Quantifying uncertainty: physicians' estimates of infection in critically ill neonates and children.

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Serval ID
serval:BIB_17468C026772
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Quantifying uncertainty: physicians' estimates of infection in critically ill neonates and children.
Journal
Clinical Infectious Diseases
Author(s)
Fischer J.E., Harbarth S., Agthe A.G., Benn A., Ringer S.A., Goldmann D.A., Fanconi S.
ISSN
1537-6591
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
38
Number
10
Pages
1383-1390
Language
english
Abstract
To determine the diagnostic accuracy of physicians' prior probability estimates of serious infection in critically ill neonates and children, we conducted a prospective cohort study in 2 intensive care units. Using available clinical, laboratory, and radiographic information, 27 physicians provided 2567 probability estimates for 347 patients (follow-up rate, 92%). The median probability estimate of infection increased from 0% (i.e., no antibiotic treatment or diagnostic work-up for sepsis), to 2% on the day preceding initiation of antibiotic therapy, to 20% at initiation of antibiotic treatment (P<.001). At initiation of treatment, predictions discriminated well between episodes subsequently classified as proven infection and episodes ultimately judged unlikely to be infection (area under the curve, 0.88). Physicians also showed a good ability to predict blood culture-positive sepsis (area under the curve, 0.77). Treatment and testing thresholds were derived from the provided predictions and treatment rates. Physicians' prognoses regarding the presence of serious infection were remarkably precise. Studies investigating the value of new tests for diagnosis of sepsis should establish that they add incremental value to physicians' judgment.
Keywords
Child, Cohort Studies, Critical Illness, Decision Making, Drug Therapy, Female, Humans, Infant, Newborn, Infection/diagnosis, Infection/drug therapy, Male, Physicians, Predictive Value of Tests, Prospective Studies, Uncertainty
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2008 11:07
Last modification date
25/09/2019 7:08
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