Prediction models in reproductive medicine: a critical appraisal
Prediction models in reproductive medicine: a critical appraisal
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DOI：
10.1093/humupd/dmp013
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发表时间：
2009-09-01
影响因子：
13.3
通讯作者：
Hompes, Peter G. A.
中科院分区：
文献类型：
--
作者：
Leushuis, Esther;van der Steeg, Jan Willem;Hompes, Peter G. A.
生殖医学领域已开发出预测模型，以帮助评估依赖治疗（不依赖治疗）的妊娠的机会。在将这些模型应用于临床实践之前，需要进行仔细的评估。我们系统地检索了文献，查找报告生殖医学预测模型的论文，针对三种策略：期待管理、宫内授精（IUI）或体外受精（IVF）。我们评估了这些模型已经通过的开发阶段，区分 (i) 模型推导、(ii) 内部和/或外部验证以及 (iii) 影响分析。我们总结了它们在区分和校准方面在外部验证中的表现。我们确定了 36 篇论文，报告了 29 个预测模型。有 9 个预测独立治疗妊娠的模型，3 个预测 IUI 后妊娠的模型，17 个预测 IVF 后妊娠的模型。所有模型均已完成模型推导阶段。对于六个模型，仅在模型开发的人群中评估模型的有效性（内部验证）。对于八个模型，在模型开发群体以外的人群中评估了有效性（外部验证），其中只有三个表现出良好的性能。 1个模型已进入影响分析阶段。目前有3个模型具有良好的预测性能。这些模型可以可靠地用作针对与发育人群类似的患者制定生育治疗决策的指南。必须进一步研究在患者护理中使用这些模型的效果。
Prediction models have been developed in reproductive medicine to help assess the chances of a treatment-(in)dependent pregnancy. Careful evaluation is needed before these models can be implemented in clinical practice.We systematically searched the literature for papers reporting prediction models in reproductive medicine for three strategies: expectant management, intrauterine insemination (IUI) or in vitro fertilization (IVF). We evaluated which phases of development these models had passed, distinguishing between (i) model derivation, (ii) internal and/or external validation, and (iii) impact analysis. We summarized their performance at external validation in terms of discrimination and calibration.We identified 36 papers reporting on 29 prediction models. There were 9 models for the prediction of treatment-independent pregnancy, 3 for the prediction of pregnancy after IUI and 17 for the prediction of pregnancy after IVF. All of the models had completed the phase of model derivation. For six models, the validity of the model was assessed only in the population in which it was developed (internal validation). For eight models, the validity was assessed in populations other than the one in which the model was developed (external validation), and only three of these showed good performance. One model had reached the phase of impact analysis.Currently, there are three models with good predictive performance. These models can be used reliably as a guide for making decisions about fertility treatment, in patients similar to the development population. The effects of using these models in patient care have to be further investigated.