Performance of Bayesian feedback to forecast lidocaine serum concentration: Evaluation of the prediction error and the prediction interval

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Abstract
The prediction performance of the Bayesian feedback method was evaluated with respect to accuracy and precision, and efficacy and safety (width of the prediction interval) on the basis of 90 predictions in 30 patients treated with lidocaine. The mean of the prediction error (PE)and the root mean squared error (RMSE)served as a measure of accuracy and precision. The variance of the standardized prediction error (SPE)was used to evaluate the estimate of the standard deviation of the prediction error. SPEwas defined as PEdivided by the standard deviation of the predicted concentration. The standard error of RMSE and of the variance of SPEwas determined by bootstrap. The results indica te that thelidocaine serum concentration at 12 hr(C2)afterstarting continuous infusion can be predicted with high accuracy and precision with a single feedback measurement obtained 2 –4 hr (C1)after commencement of treatment: RMSE=20.6%. Prediction at 24 hr (C3)was less accurate: RMSE =31.4%. Using both C1and C2 to predict C3 improved precision (RMSE=23.4%).The evaluation of the prediction interval revealed that the current algorithm produces an upward biased estimate,probably due to a positive bias in the estimate of the covariance matrix of the parameter estimates. It is suggested that evaluation of prediction performance should include the estimate of the prediction interval.