Imperial College London

Professor Anthony Gordon

Faculty of MedicineDepartment of Surgery & Cancer

Chair in Anaesthesia and Critical Care







ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus






BibTex format

author = {Nagendran, M and Chen, Y and Gordon, AC},
doi = {10.7861/clinmed.2019-0169},
journal = {Clinical medicine (London, England)},
pages = {369--374},
title = {Real time self-rating of decision certainty by clinicians: a systematic review.},
url = {},
volume = {19},
year = {2019}

RIS format (EndNote, RefMan)

AB - BackgroundWe sought to establish to what extent decision certainty has been measured in real time and whether high or low levels of certainty correlate with clinical outcomes.MethodsOur pre-specified study protocol is published on PROSPERO, CRD42019128112. We identified prospective studies from Medline, Embase and PsycINFO up to February 2019 that measured real time self-rating of the certainty of a medical decision by a clinician.FindingsNine studies were included and all were generally at high risk of bias. Only one study assessed long-term clinical outcomes: patients rated with high diagnostic uncertainty for heart failure had longer length of stay, increased mortality and higher readmission rates at 1 year than those rated with diagnostic certainty. One other study demonstrated the danger of extreme diagnostic confidence - 7% of cases (24/341) labelled as having either 0% or 100% diagnostic likelihood of heart failure were made in error.ConclusionsThe literature on real time self-rated certainty of clinician decisions is sparse and only relates to diagnostic decisions. Further prospective research with a view to generating hypotheses for testable interventions that can better calibrate clinician certainty with accuracy of decision making could be valuable in reducing diagnostic error and improving outcomes.
AU - Nagendran,M
AU - Chen,Y
AU - Gordon,AC
DO - 10.7861/clinmed.2019-0169
EP - 374
PY - 2019///
SN - 1470-2118
SP - 369
TI - Real time self-rating of decision certainty by clinicians: a systematic review.
T2 - Clinical medicine (London, England)
UR -
UR -
UR -
UR -
VL - 19
ER -