The Cascade Effect in the Clinical Care of Patients

IN biology, the term "cascade" refers to a process that, once started, proceeds stepwise to its full, seemingly inevitable, conclusion. Common examples are the clotting cascade and the complement cascade. Processes that occur in molecular systems often have correlates in larger systems. It is our contention that cascade effects are frequently operative in the clinical care of patients, and that recognition of this fact gives us a better understanding of the clinical decision-making process.The cascade effect that we will describe generally consists of an initiating factor or factors, followed by a series of events that seem to be a . . .