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• W2071237892 abstract "In this issue of Surgery, Amin and Kulkarni describe the application of fuzzy logic to the components of the Glasgow Coma Score, reporting an improvement in the prediction of cognitive recovery after head injury. Three aspects of this report warrant comment. First, there is the matter of the name fuzzy logic. Surgeons do not like much that is fuzzy. Invidious comparisons jump to mind—fuzzy thinking, fuzzy on the issues, fuzzy techniques—and such associations speak to a prejudice that is hard to overcome. Such prejudice is unfortunate because surgeons are (unbeknownst to most) consummate practitioners of fuzzy logic. Every surgeon carries a mental “odds book” by which the risks and probable outcomes of procedures are estimated. You are told that the patient in the exam room has cholelithiasis and needs a cholecystectomy. How does the vision of the operation and of the outcomes change when you open the door and observe that the patient is 20 years older, a hundred pounds fatter, with a CABG scar on the chest, and a dozen medications on the table? Instantly you know not only that the probable outcomes have changed but also that the individual comorbidities “talk” to one another in ways that are difficult to describe but that are nevertheless familiar and significant. The application of fuzzy logic is merely a formal means of codifying those interactions, a multivariate analysis strategy that accounts for interactions among terms without explicitly defining them. Here lies an opportunity for surgeons to wring additional information from existing data. Second, there is the issue of prediction. We surgeons are used to discrete predictions and outcomes: a complication will or will not occur, a patient will survive or die. Fuzzy logic extracts information from interactions among interdependent variables but at a cost: The predictions themselves are probabilistic, not absolute. The fuzzy classifiers can only reduce the uncertainty surrounding outcomes—they cannot predict any outcome with certainty. Yet surgeons should take comfort in the uncertainty, and more importantly in the relatively strict mathematics that allow one to quantify just how much uncertainty a fuzzy classifier is capable of removing from the prediction. Third, there is the issue of the Glasgow Coma Scale itself. The scale was designed and intended to assess for change in cognition and responsiveness by multiple raters over short periods of time. Tuned to reduce interrater variability at a moment, its unintended service as a predictor of outcome has been embraced with a passion that sometimes defies reason. Thermal instability, drugs, and intercurrent sepsis all can confound this simple measure. With apologies to the Latin scholars in the readership, caveat calculator. The editorial ends here, with the understanding that those who have bothered to read this commentary should now log onto the internet, enter the URL where the data and fuzzy logic calculator have been cataloged (www.mosby.com/surgery ) and explore. Like surgery, the application of new analytic tools is not a spectator sport." @default.
• W2071237892 created "2016-06-24" @default.
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• W2071237892 date "2000-03-01" @default.
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• W2071237892 title "Invited commentary: Fuzzy logic, clear reasoning" @default.
• W2071237892 doi "https://doi.org/10.1067/msy.2000.104298" @default.
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