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Predicting the Future: A Case Study in Prognostication.

Purpose
Clinicians are regularly asked to make long-term prognoses. The aim of the current report was to present one systematic approach to doing so. A case example from a malpractice case involving a child fitted with a cochlear implant was presented. Implantation occurred at age 17 months (activation 1 month later), but due to a procedural error, the implant was not functional for 19 months. The problem was ultimately rectified, but the legal case hinged largely on whether the child would be able to make up for the lost time.


Method
A review of the literature on long-term outcomes in children with cochlear implants was conducted. Using 4 studies measuring outcomes 7-10 years later, outcomes were compared between children implanted at age 17-18 months and those implanted at age 36-37 months.


Results
Analysis suggested no potential impact on nonverbal cognitive skills. However, analysis in the areas of speech perception, word comprehension, speech intelligibility, and reading suggested that after 7-10 years, this child would potentially continue to be approximately 1-2 years behind where she might otherwise have been.


Conclusions
This case illustrated the possibility of deriving a long-term prognosis using a systematic examination of the existing outcomes literature. Such an approach is consistent with our mandate to engage in evidence-based practice.