TY - JOUR 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 - http://dx.doi.org/10.7861/clinmed.2019-0169 UR - https://www.ncbi.nlm.nih.gov/pubmed/31530683 UR - http://www.clinmed.rcpjournal.org/content/19/5/369 UR - http://hdl.handle.net/10044/1/73646 VL - 19 ER -