The Discrepancy between Daily Practice and the Policy of a Decision-analytic Model

Abstract

The optimal treatment of children with fever of unknown origin is controversial, in spite of two decision analyses that advise treatment with antibiotics for all such children. The aim of this study was to analyze the differences between pediatricians' diagnostic and therapeutic decisions and the outcomes of the decision-analytic models. Thirty- six pediatricians were asked to evaluate 30 patient cases and to give their diagnostic and therapeutic judgments. In addition, the pediatricians were asked questions about the epidemiology of fever of unknown origin. Analyses showed that the differences in policy between pediatricians and the models could not be explained by the reasons mentioned in the literature, i.e., 1) differences in epidemiologic data used, 2) differ ences in the weighting of clinical information, and 3) differences in the evaluation of outcomes. The differences in policy might be due to a difference between the objective of the models and pediatricians' aim. In a curative setting, pediatricians are not trying to prevent meningitis (or another serious disease) by treating possible occult bacter emia, but rather aim to detect meningitis in an early stage. A decision analysis deter mining the most cost-effective strategy for early detection of meningitis might therefore be more easily accepted by pediatricians. Key words: diagnostic and therapeutic de cisions ; decision-analytic models; fever of unknown origin. (Med Decis Making 1996; 16:357-366)