Feedback loops in intensive care unit prognostic models: an under-recognised threat to clinical validity
Bibliographic record
Abstract
Prognostic models developed for use in the intensive care unit (ICU) can inform treatment decisions and improve patient care. However, despite extensive research, few models have contributed to improved patient-centred outcomes. A major limitation is that the influence of treatment interventions on patient outcomes during model development and validation is often overlooked. Upon implementation, prognostic models can affect clinical interventions, creating feedback loops that alter the relationship between predictors and observed patient outcomes. This alteration caused by model-mediated intervention is known as model drift. Positive feedback loops reinforce initial prognoses, leading to self-fulfilling prophecies, whereas negative feedback loops obscure the efficacy of successful interventions by rendering them as apparent model inaccuracies. To mitigate these issues, prognostic models for use in ICUs should account for treatment effects and the causal relationships among predictions, interventions, and outcomes. Thus, collaboration among data scientists, epidemiologists, clinical researchers, and implementation scientists is required to ensure that prognostic models enhance patient care without causing inadvertent harm.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.129 | 0.333 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.005 | 0.004 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.005 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.006 | 0.004 |
| Research integrity | 0.004 | 0.011 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".