Creation of a Clinical Prediction Rule

Clinical prediction rules should undergo a specific set of steps prior to adoption of the rule in clinical practice. Some rules are well studied and studies in each step have been published. However, there are several clinical prediction rules that clinicians have adopted prior to validation and impact analysis. Premature adoption of a rule or application to a group of people that the rule has not been validated in may unnecessarily place patients at risk.


Step 1: Derivation

Factors are identified that have statistically significant predictive power


Step 2: Validation

Reproducible accuracy of the derived clinical prediction rule is observed
Narrow Validation: applied in similar clinical setting & population to the derivation stage
Broad Validation: applied in multiple clinical settings with varying disease prevalence


Step 3: Impact Analysis

Impact of the clinical prediction rule in clinical practice and/or patient outcome is observed

Not All Rules are the Same


Useful in the diagnosis or categorization of the patient.


the identification of the nature of an illness or other problem by examination of the symptoms.

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Useful in the prediction of patient outcomes.


a forecast of the likely course of a disease or ailment.

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Useful in choosing the most effective treatment or the one to which your patient is most likely to respond.


an instruction by a healthcare practitioner that authorizes a patient to be provided medicine or treatment.

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