title: Clinician vs mathematical statistical models: which is better at predicting an abnormal chest radiograph finding in injured patients?
abstract: OBJECTIVE
  The purpose of this study was to determine if statistical models for prediction of chest injuries would outperform the clinician's (MD) ability to identify injured patients at risk for a thoracic injury diagnosed by chest radiograph (CXR).
  
  
  METHODS
  A prospective observational study was done during a 12-month period.
  
  
  METHODS
  The study was conducted in a level I trauma center.
  
  
  METHODS
  Injured patients meeting trauma team activation criteria were enrolled to the study.
  
  
  METHODS
  Physical examination findings by a clinician were interpreted and CXR was performed.
  
  
  METHODS
  The accuracy of 2 mathematical models is compared against the accuracy of clinician's clinical judgment in predicting an injury by CXR. Two newly constructed multivariate models, binary logistic regression (LR) and classification and regression tree (CaRT) analysis, are compared to previously published data of clinician clinical assessment of probability of thoracic injury identified by CXR.
  
  
  RESULTS
  Data for 757 patients were analyzed. Classification and regression tree analysis developed a stepwise decision tree to determine which signs/symptoms were indicative of an abnormal CXR finding. The sensitivity (CaRT, 36.6%; LR, 36.3%; MD, 58.7%), specificity (CaRT, 98.3%; LR, 98.2%; MD, 96.4%), and error rates (CaRT, 0.93; LR, 0.94; MD, 0.82) show that the mathematical decision aids are less sensitive and risk more misclassification compared to clinician judgment in predicting an injury by CXR.
  
  
  CONCLUSIONS
  Clinician judgment was superior to mathematical decision aids for predicting an abnormal CXR finding in injured patients with chest trauma.
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60157, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dillard
authors.forename: Fred A
authors.initials: FA
authors.lastname: Luchette
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Sears
authors.forename: John
authors.initials: J
authors.lastname: Norton
authors.forename: Carol R
authors.initials: CR
authors.lastname: Schermer
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Reed
authors.forename: Richard L
authors.initials: RL
authors.lastname: Gamelli
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003663:Decision Trees; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D015599:Trauma Severity Indices