Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically describes the potential impact of treatment effects in model development studies. Treatment effects may lead to models failing to achieve the aim of identifying the patients most likely to benefit from intervention, and may instead identify patients who are unlikely to benefit from intervention. The paper provides practical advice to help clinicians who wish to use clinical prediction scores to assist clinical judgement rather than dictate clinical decision making.
- clinical assessment
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Handling editor Richard Body
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SG was the Chief Investigator for the PRIEST Study.
Provenance and peer review Not commissioned; externally peer reviewed.