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Prognostic Index for 4-Year Mortality in Older Adults—Reply
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In Reply: Dr Taylor raises a concern about patients with somatoform disorders overreporting medical conditions and functional limitations, resulting in falsely elevated estimates of 4-year mortality risk. This highlights the importance of incorporating clinical judgment when interpreting the results from any prognostic index. Our index should be used in consultation with a clinician, so that prognostic information, patient preference, medical evidence, and clinician judgment can all contribute to the interpretation of risk scores. While we demonstrated that our index is accurate on a population level, the concern raised by Taylor is one of many reasons that a prognostic risk score may be less accurate when applied to an individual patient.
Drs de Craen and Westendorp report an analysis of the Dutch population, where an age and sex only model had an AUC of 0.79, concluding that the marginal benefit of the other 10 questions of our mortality index was 0.03 . . . [Full Text of this Article]
Sei J. Lee, MD
sei.lee@med.va.gov
Kenneth E. Covinsky, MD, MPH
Division of Geriatrics
San Francisco VA Medical Center
San Francisco, Calif
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