{"id":"https://openalex.org/W4416469290","doi":"https://doi.org/10.1038/s41746-025-02079-y","title":"The hidden risk of round numbers and sharp thresholds in clinical practice","display_name":"The hidden risk of round numbers and sharp thresholds in clinical practice","publication_year":2025,"publication_date":"2025-11-21","ids":{"openalex":"https://openalex.org/W4416469290","doi":"https://doi.org/10.1038/s41746-025-02079-y","pmid":"https://pubmed.ncbi.nlm.nih.gov/41272088"},"language":"en","primary_location":{"id":"doi:10.1038/s41746-025-02079-y","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-025-02079-y","pdf_url":"https://www.nature.com/articles/s41746-025-02079-y.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"npj Digital Medicine","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.nature.com/articles/s41746-025-02079-y.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5068931679","display_name":"Benjamin J. Lengerich","orcid":"https://orcid.org/0000-0001-8690-9554"},"institutions":[{"id":"https://openalex.org/I107606265","display_name":"Broad Institute","ror":"https://ror.org/05a0ya142","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I107606265"]},{"id":"https://openalex.org/I135310074","display_name":"University of Wisconsin\u2013Madison","ror":"https://ror.org/01y2jtd41","country_code":"US","type":"education","lineage":["https://openalex.org/I135310074"]},{"id":"https://openalex.org/I63966007","display_name":"Massachusetts Institute of Technology","ror":"https://ror.org/042nb2s44","country_code":"US","type":"education","lineage":["https://openalex.org/I63966007"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Benjamin J. Lengerich","raw_affiliation_strings":["Broad Institute of MIT and Harvard, Cambridge, MA, USA. lengerich@wisc.edu","Massachusetts Institute of Technology, Cambridge, MA, USA. lengerich@wisc.edu","University of Wisconsin, Madison, WI, USA. lengerich@wisc.edu","Broad Institute of MIT and Harvard, Cambridge, MA, USA","Massachusetts Institute of Technology, Cambridge, MA, USA"],"affiliations":[{"raw_affiliation_string":"Broad Institute of MIT and Harvard, Cambridge, MA, USA. lengerich@wisc.edu","institution_ids":["https://openalex.org/I107606265"]},{"raw_affiliation_string":"Massachusetts Institute of Technology, Cambridge, MA, USA. lengerich@wisc.edu","institution_ids":["https://openalex.org/I63966007"]},{"raw_affiliation_string":"University of Wisconsin, Madison, WI, USA. lengerich@wisc.edu","institution_ids":["https://openalex.org/I135310074"]},{"raw_affiliation_string":"Broad Institute of MIT and Harvard, Cambridge, MA, USA","institution_ids":["https://openalex.org/I107606265"]},{"raw_affiliation_string":"Massachusetts Institute of Technology, Cambridge, MA, USA","institution_ids":["https://openalex.org/I63966007"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5083893060","display_name":"Rich Caruana","orcid":"https://orcid.org/0000-0002-6383-7786"},"institutions":[{"id":"https://openalex.org/I1290206253","display_name":"Microsoft (United States)","ror":"https://ror.org/00d0nc645","country_code":"US","type":"company","lineage":["https://openalex.org/I1290206253"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Rich Caruana","raw_affiliation_strings":["Microsoft Research, Redmond, WA, USA"],"affiliations":[{"raw_affiliation_string":"Microsoft Research, Redmond, WA, USA","institution_ids":["https://openalex.org/I1290206253"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5015575648","display_name":"Mark Nunnally","orcid":"https://orcid.org/0000-0003-2129-4733"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Mark E. Nunnally","raw_affiliation_strings":["NYU Langone Health, New York City, NY, USA"],"affiliations":[{"raw_affiliation_string":"NYU Langone Health, New York City, NY, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5109338509","display_name":"Manolis Kellis","orcid":null},"institutions":[{"id":"https://openalex.org/I107606265","display_name":"Broad Institute","ror":"https://ror.org/05a0ya142","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I107606265"]},{"id":"https://openalex.org/I63966007","display_name":"Massachusetts Institute of Technology","ror":"https://ror.org/042nb2s44","country_code":"US","type":"education","lineage":["https://openalex.org/I63966007"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Manolis Kellis","raw_affiliation_strings":["Broad Institute of MIT and Harvard, Cambridge, MA, USA","Massachusetts Institute of Technology, Cambridge, MA, USA"],"affiliations":[{"raw_affiliation_string":"Broad Institute of MIT and Harvard, Cambridge, MA, USA","institution_ids":["https://openalex.org/I107606265"]},{"raw_affiliation_string":"Massachusetts Institute of Technology, Cambridge, MA, USA","institution_ids":["https://openalex.org/I63966007"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5068931679"],"corresponding_institution_ids":["https://openalex.org/I107606265","https://openalex.org/I135310074","https://openalex.org/I63966007"],"apc_list":{"value":3060,"currency":"USD","value_usd":3060},"apc_paid":{"value":3060,"currency":"USD","value_usd":3060},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.47223444,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"8","issue":"1","first_page":"711","last_page":"711"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10218","display_name":"Sepsis Diagnosis and Treatment","score":0.651199996471405,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10218","display_name":"Sepsis Diagnosis and Treatment","score":0.651199996471405,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11011","display_name":"Frailty in Older Adults","score":0.04190000146627426,"subfield":{"id":"https://openalex.org/subfields/2717","display_name":"Geriatrics and Gerontology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.026000000536441803,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/clinical-practice","display_name":"Clinical Practice","score":0.7350999712944031},{"id":"https://openalex.org/keywords/risk-assessment","display_name":"Risk assessment","score":0.4189999997615814},{"id":"https://openalex.org/keywords/clinical-judgment","display_name":"Clinical judgment","score":0.36820000410079956},{"id":"https://openalex.org/keywords/intensive-care","display_name":"Intensive care","score":0.34619998931884766},{"id":"https://openalex.org/keywords/classification-of-discontinuities","display_name":"Classification of discontinuities","score":0.33169999718666077},{"id":"https://openalex.org/keywords/longitudinal-data","display_name":"Longitudinal data","score":0.32739999890327454}],"concepts":[{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.7350999712944031},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.439300000667572},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.4189999997615814},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.3855000138282776},{"id":"https://openalex.org/C3020452639","wikidata":"https://www.wikidata.org/wiki/Q454812","display_name":"Clinical judgment","level":2,"score":0.36820000410079956},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.36079999804496765},{"id":"https://openalex.org/C112930515","wikidata":"https://www.wikidata.org/wiki/Q4389547","display_name":"Risk analysis (engineering)","level":1,"score":0.35280001163482666},{"id":"https://openalex.org/C2987404301","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care","level":2,"score":0.34619998931884766},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.34049999713897705},{"id":"https://openalex.org/C15627037","wikidata":"https://www.wikidata.org/wiki/Q541961","display_name":"Classification of discontinuities","level":2,"score":0.33169999718666077},{"id":"https://openalex.org/C3020672099","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Longitudinal data","level":2,"score":0.32739999890327454},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3140999972820282},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.2996000051498413},{"id":"https://openalex.org/C32896092","wikidata":"https://www.wikidata.org/wiki/Q189447","display_name":"Risk management","level":2,"score":0.28859999775886536},{"id":"https://openalex.org/C2776902269","wikidata":"https://www.wikidata.org/wiki/Q5165493","display_name":"Continuous monitoring","level":2,"score":0.26739999651908875},{"id":"https://openalex.org/C2777093003","wikidata":"https://www.wikidata.org/wiki/Q6508345","display_name":"Lead (geology)","level":2,"score":0.25270000100135803}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1038/s41746-025-02079-y","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-025-02079-y","pdf_url":"https://www.nature.com/articles/s41746-025-02079-y.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"npj Digital Medicine","raw_type":"journal-article"},{"id":"pmid:41272088","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41272088","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"NPJ digital medicine","raw_type":null},{"id":"pmh:oai:doaj.org/article:d8ff28f489ad4d4298913feeaa084838","is_oa":true,"landing_page_url":"https://doaj.org/article/d8ff28f489ad4d4298913feeaa084838","pdf_url":null,"source":{"id":"https://openalex.org/S112646816","display_name":"SHILAP Revista de lepidopterolog\u00eda","issn_l":"0300-5267","issn":["0300-5267","2340-4078"],"is_oa":true,"is_in_doaj":true,"is_core":false,"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"npj Digital Medicine, Vol 8, Iss 1, Pp 1-8 (2025)","raw_type":"article"},{"id":"pmh:oai:europepmc.org:11445777","is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12638946","pdf_url":null,"source":{"id":"https://openalex.org/S4306400806","display_name":"Europe PMC (PubMed Central)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I1303153112","host_organization_name":"European Bioinformatics Institute","host_organization_lineage":["https://openalex.org/I1303153112"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1038/s41746-025-02079-y","is_oa":true,"landing_page_url":"https://doi.org/10.1038/s41746-025-02079-y","pdf_url":"https://www.nature.com/articles/s41746-025-02079-y.pdf","source":{"id":"https://openalex.org/S4210195431","display_name":"npj Digital Medicine","issn_l":"2398-6352","issn":["2398-6352"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319908","host_organization_name":"Nature Portfolio","host_organization_lineage":["https://openalex.org/P4310319908","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Nature Portfolio","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"npj Digital Medicine","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4416469290.pdf","grobid_xml":"https://content.openalex.org/works/W4416469290.grobid-xml"},"referenced_works_count":21,"referenced_works":["https://openalex.org/W1967042859","https://openalex.org/W1995945562","https://openalex.org/W1996796871","https://openalex.org/W2046788142","https://openalex.org/W2075626076","https://openalex.org/W2081610790","https://openalex.org/W2105119992","https://openalex.org/W2105976328","https://openalex.org/W2123774149","https://openalex.org/W2143569590","https://openalex.org/W2396881363","https://openalex.org/W2523755105","https://openalex.org/W2912934387","https://openalex.org/W2973631113","https://openalex.org/W2990895485","https://openalex.org/W3087541343","https://openalex.org/W4200632480","https://openalex.org/W4244832599","https://openalex.org/W4247943214","https://openalex.org/W4293242440","https://openalex.org/W4297957988"],"related_works":[],"abstract_inverted_index":{"Clinical":[0],"decision-making":[1],"often":[2],"simplifies":[3],"continuous":[4,82,103],"risk":[5,17,74],"data":[6],"into":[7],"discrete":[8],"levels":[9],"using":[10],"round-number":[11,48],"thresholds.":[12],"These":[13],"simplifications":[14],"can":[15,50],"distort":[16],"assessments.":[18],"To":[19],"systematically":[20],"uncover":[21],"these":[22,64],"distortions,":[23],"we":[24,45],"develop":[25],"an":[26],"interpretable":[27],"machine":[28],"learning":[29],"model":[30],"that":[31],"identifies":[32],"anomalies":[33,65],"caused":[34],"by":[35,98],"threshold-based":[36],"practices.":[37],"Through":[38],"simulations,":[39],"real-world":[40],"data,":[41],"and":[42,54,72],"longitudinal":[43],"studies,":[44],"demonstrate":[46],"how":[47],"thresholds":[49,100],"lead":[51],"to":[52,94],"discontinuities":[53],"counter-causal":[55],"paradoxes":[56],"in":[57,62,77,88],"mortality":[58],"risk.":[59,106],"Despite":[60],"advances":[61],"medicine,":[63],"persist,":[66],"underscoring":[67],"the":[68,102],"need":[69],"for":[70],"dynamic":[71],"nuanced":[73],"assessment":[75],"methods":[76],"healthcare.":[78],"Our":[79],"findings":[80],"suggest":[81],"reassessment":[83],"of":[84,105],"clinical":[85],"protocols,":[86],"especially":[87],"critical":[89],"settings":[90],"like":[91],"intensive":[92],"care,":[93],"improve":[95],"patient":[96],"outcomes":[97],"aligning":[99],"with":[101],"nature":[104]},"counts_by_year":[],"updated_date":"2026-03-20T23:20:44.827607","created_date":"2025-11-23T00:00:00"}
