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October 10, 2001

Use of Prognostic Indexes for Determining Malpractice Liability—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(14):1712-1713. doi:10.1001/jama.286.14.1709

In Reply: Dr Smith makes a thoughtful comment about using clinical predictive indices to modulate excessive medical litigation. However, the prognostic index for elderly patients may not be sufficient for this worthwhile goal.1 First, only a minority of patients will score in the highest bedside quintile at which the estimated risk of death is about 65%. Furthermore, an estimated risk of death of 65% may not excuse an adverse event that follows a perceived shortfall of care. Second, most fatalities will occur among patients whose estimated risks of death are less than 50%. Such fatalities in individuals who were not expected to die are likely to arouse demands for more explanation. Finally, the use of statistical reasoning is sometimes problematic in legal courts because of ambiguities over the appropriate referent population.2 For example, how many therapeutic triumphs in other patients can justify a single lapse in 1 identified patient?

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