Should we use composite outcomes in obstetric clinical prediction models?

Autor: Giles-Clark HJ; Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia. Electronic address: holly.giles-clark@monash.edu., Skinner SM; Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia. Electronic address: sasha.skinner1@monash.edu., Rolnik DL; Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia. Electronic address: daniel.rolnik@monash.edu., Mol BW; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. Electronic address: ben.mol@monash.edu.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2023 Jun; Vol. 285, pp. 193-197. Date of Electronic Publication: 2023 May 02.
DOI: 10.1016/j.ejogrb.2023.04.031
Abstrakt: Clinical prediction models assist clinicians to estimate the natural course of a condition, and thus facilitate treatment decisions. The development of prediction models is increasingly common in obstetric research. Composite outcomes, whereby multiple outcomes are combined into a single endpoint, are frequently used in obstetric prediction models to increase statistical power when predicting rare events. Although existing literature has reviewed the positives and negatives of using composite outcomes in clinical trials, there has been minimal commentary on the implications of their use in the development and reporting of prognostic models. In this article, we review these issues, in particular, highlighting how unequal individual relationships between predictors and individual component outcomes can result in misleading conclusions, which may result in the omission of important but rare predictors or inappropriately inform clinical decisions to implement an intervention. We propose careful use, or where possible avoidance, of composite outcomes in the development of prognostic models in obstetrics. Methodological standards for developing prognostic models should be updated to standardise and appraise composite outcomes when their use is necessary. We also support previous recommendations to report on the accuracy of key components and inconsistencies among predictor variables.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: B.W.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva and Merck and travel support from Merck.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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