Article Text

Download PDFPDF
Using clinical risk models to predict outcomes: what are we predicting and why?
  1. Steve Goodacre
  1. School of Health and Related Research, The University of Sheffield, Sheffield, S10 2TN, UK
  1. Correspondence to Professor Steve Goodacre, School of Health and Related Research, The University of Sheffield, Sheffield, S10 2TN, UK; s.goodacre{at}


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
  • research
  • statistics

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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.