Hemodynamic Assessment in Managing the Critically III

Abstract

Prior to right-heart catheterization of 846 patients, 198 study physicians estimated values of pulmonary capillary wedge pressure (WP), cardiac index (Cl), and systemic vascular resistance index (VRI). The physicians also expressed their confidence in these estimates. Actual values of WP, Cl, and VRI as determined by catheterization enabled the authors to evaluate the quality of the physicians' judgments. The discrimination of the judgments was modest; areas under the ROC curves for WP, Cl, and VRI were 0.724, 0.681, and 0.656, respectively. Calculated using clinically relevant cutoff values, sensitivities were 64%, 50%, and 64%, and specificities were 71%, 75%, and 63%, respectively. Calibration of the estimates of WP, Cl, and VRI was also modest; physicians tended to overestimate low values and underestimate high values. Physicians were generally confident of their estimates, but there was no relation between confidence and accuracy. Experienced physicians were no more accurate than less experienced ones, although they were significantly more confident. The authors conclude that physicians should not use their levels of confidence in their subjective estimates of cardiac function in deciding whether to base therapy on these estimates.

Confidence and accuracy in assessments of short-term risks presented by forensic psychiatric patients

“…In their review of clinical psychological judgment, Wedding and Faust (1989) noted a lack of evidence that accuracy is related to experience, expertise, or confidence in the correctness of predictions. Additionally, although confidence increases with experience, accuracy does not (Dawson et al, 1993). High confidence 2 S.L.…”

Pre-operative diagnostic radiograph interpretation by general dental practitioners for root canal treatment

“…33 Also in Table 2, 11 practitioners said they will be detecting the number of root canals, but it has been shown that a conventional radiograph has low detection potential for assessing lateral or accessory canals. 43, 44 Dawson et al 45 hypothesized that diagnosis of periapical lesion is not influenced by diagnostic confidence; dentists who feel confident about diagnosing pathology from radiographs are not necessarily able to correctly diagnose the lesion. 46 This was proven in a study by Stheeman et al 47 where a dentist's ability to diagnose a radio-opaque lesion was independent of their diagnostic confidence and their diagnostic ability increased when they were more confident regarding the lesion when confronted with a radiograph.…”

Stroke Volume Optimization: The New Hemodynamic Algorithm

“…Although the values obtained in these assessments somewhat correlate with hemodynamic variables, the values are slow to change and the changes are often late indications of a patient's worsening condition. [3][4][5] Several studies [10][11][12][13][14][15][16][17] suggest that using physical assessment to evaluate cardiac output may yield inaccurate findings. More recent data [18][19][20] suggest that the predictive power of blood lactate levels for mortality and morbidity are independent of blood pressure and common physiological triage variables (eg, heart rate, blood pressure, mental status, capillary refill).…”