Methods
In a prediction rule study, investigators identify a consecutive group of patients who are suspected of having a specific disease or outcome. The investigators then obtain a standard set of clinical observations on each patient and a test or clinical follow-up to define the true state of the patient. They then use statistical methods to identify the best clinical predictors of the patient's true state. The probability of disease will depend on the patient's key clinical predictors. Published methodological standards specify good practices for developing a clinical prediction rule. A survey of methods concluded "the majority of prediction studies in high impact journals do not follow current methodological recommendations, limiting their reliability and applicability", confirming earlier findings from the diabetic literature. The TRIPOD statement is now widely used to improve the quality of reporting of clinical prediction rules,Collins GS, Reitsma HB, Altman DG, Moons KGM. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): The TRIPOD Statement. Ann Intern Med. 2015;162:55-63 with an extension to provide guidance for clinical prediction rules developed usingEffect on health outcomes
Few prediction rules have had the consequences of their usage by physicians quantified. When studied, the impact of providing the information alone (for example, providing the calculated probability of disease) has been negative. However, when the prediction rule is implemented as part of a critical pathway, so that a hospital or clinic has procedures and policies established for how to manage patients identified as high or low risk of disease, the prediction rule has more impact on clinical outcomes. The more intensively the prediction rule is implemented the more benefit will occur.Examples of prediction rules
* Apache II * CHADS2 for risk of stroke withReferences
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