GRADE concept paper 8: judging the certainty of discrimination performance estimates of prognostic models in a body of validation studies.

Autor: Foroutan F; Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address: Farid.foroutan@uhn.ca., Mayer M; DynaMed Decisions, EBSCO Clinical Decisions, EBSCO, Ipswich, MA, USA; Open Door Clinic, Cone Health, Greensboro, NC, USA., Guyatt G; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Riley RD; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, England, UK; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK., Mustafa R; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas School of Medicine, Kansas City, MO, USA., Kreuzberger N; Evidence-Based Medicine, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Skoetz N; Evidence-Based Medicine, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Darzi A; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada., Alba AC; Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada., Mowbray F; College of Nursing, Michigan State University, Kansas City, MI, USA., Rayner DG; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada., Schunemann H; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Iorio A; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Jazyk: angličtina
Zdroj: Journal of clinical epidemiology [J Clin Epidemiol] 2024 Jun; Vol. 170, pp. 111344. Date of Electronic Publication: 2024 Apr 03.
DOI: 10.1016/j.jclinepi.2024.111344
Abstrakt: Background: Prognostic models incorporate multiple prognostic factors to estimate the likelihood of future events for individual patients based on their prognostic factor values. Evaluating these models crucially involves conducting studies to assess their predictive performance, like discrimination. Systematic reviews and meta-analyses of these validation studies play an essential role in selecting models for clinical practice.
Methods: In this paper, we outline 3 thresholds to determine the target for certainty rating in the discrimination of prognostic models, as observed across a body of validation studies.
Results and Conclusion: We propose 3 thresholds when rating the certainty of evidence about a prognostic model's discrimination. The first threshold amounts to rating certainty in the model's ability to classify better than random chance. The other 2 approaches involve setting thresholds informed by other mechanisms for classification: clinician intuition or an alternative prognostic model developed for the same disease area and outcome. The choice of threshold will vary based on the context. Instead of relying on arbitrary discrimination cut-offs, our approach positions the observed discrimination within an informed spectrum, potentially aiding decisions about a prognostic model's practical utility.
Competing Interests: Declaration of competing interest All authors declare they did not receive support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years exist or do other relationships or activities that could appear to have influenced the submitted work. All authors are members of the GRADE working group.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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