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Quantifying Uncertainty: Physicians' Estimates of Infection in Critically Ill Neonates and Children

Fischer, Joachim E. ; Harbarth, Stephan ; Agthe, Alexander G. ; Benn, Anne ; Ringer, Steven A. ; Goldmann, Donald A. ; Fanconi, Sergio

In: Clinical Infectious Diseases, 2004, vol. 38, no. 10, p. 1383-1390

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    Title
    • Quantifying Uncertainty: Physicians' Estimates of Infection in Critically Ill Neonates and Children
    Author
    • Fischer, Joachim E.. Children's Hospital, University of Zurich, Zurich
    • Harbarth, Stephan. Geneva University Hospitals, Geneva
    • Agthe, Alexander G.. Johns Hopkins University Hospital, Baltimore, Maryland
    • Benn, Anne. Children's Hospital, University of Zurich, Zurich
    • Ringer, Steven A.. Brigham and Women's Hospital, Boston, Massachusetts
    • Goldmann, Donald A.. Children's Hospital, Harvard Medical School, Boston, Massachusetts
    • Fanconi, Sergio. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Clinical Infectious Diseases, 2004, vol. 38, no. 10, p. 1383-1390. The University of Chicago Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:300744
    Summary
    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