Prognostic models in obstetrics: available, but far from applicable
Prognostic models in obstetrics: available, but far from applicable
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DOI：
10.1016/j.ajog.2015.06.013
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发表时间：
2016-01-01
影响因子：
9.8
通讯作者：
Schuit, Ewoud
中科院分区：
文献类型：
--
作者：
Kleinrouweler, C. Emily;Cheong-See, Fiona M.;Schuit, Ewoud
在规划进一步的测试和治疗时，卫生保健服务越来越注重对患者个体风险的预测，以发展特定的健康结果。产科中各种母婴结局的预测模型的开发和出版一直在稳步增加。我们进行了系统的综述，从产科现有的预测模型的潜在优势以及模型的开发和验证过程中，概述了产科可用预测模型的现状。评估预后模型时需要考虑的重要方面被讨论，并就如何在产科领域内进行这方面的建议进行了讨论。我们在MEDLINE(截至2012年7月)上搜索有关产科预后模型的文章。我们确定了177篇文献，报道了40种不同结果的263个预后模型的发展。最常预测的结局是先兆子痫(n=69)、早产(n=63)、分娩方式(n=22)、妊娠高血压综合征(n=11)和小于胎龄儿(n=10)。新模型的表现通常不比预测相同结果的旧模型更好。预测准确度的最重要的衡量标准(即模型的辨别和校准)通常(82.9%，218/263)没有同时进行评估。很少有开发的模型在开发数据之外的数据中得到验证(8.7%，23/263)。只有三分之二的论文(62.4%，164/263)提出了该模型，使得在其他人群中验证是可能的，只有11.0%(29/263)的论文讨论了临床适用性。开发的模型对临床实践的影响尚不清楚。我们在产科确定了大量的预后模型，但关于它们的性能、影响和在临床实践中的有效性的证据相对较少，因此在这一点上，不能推荐临床实施。应作出新的努力，评估现有模式的表现和影响。
Health care provision is increasingly focused on the prediction of patients' individual risk for developing a particular health outcome in planning further tests and treatments. There has been a steady increase in the development and publication of prognostic models for various maternal and fetal outcomes in obstetrics. We undertook a systematic review to give an overview of the current status of available prognostic models in obstetrics in the context of their potential advantages and the process of developing and validating models. Important aspects to consider when assessing a prognostic model are discussed and recommendations on how to proceed on this within the obstetric domain are given. We searched MEDLINE (up to July 2012) for articles developing prognostic models in obstetrics. We identified 177 papers that reported the development of 263 prognostic models for 40 different outcomes. The most frequently predicted outcomes were preeclampsia (n = 69), preterm delivery (n = 63), mode of delivery (n = 22), gestational hypertension (n = 11), and small-for-gestational-age infants (n = 10). The performance of newer models was generally not better than that of older models predicting the same outcome. The most important measures of predictive accuracy (ie, a model's discrimination and calibration) were often (82.9%, 218/263) not both assessed. Very few developed models were validated in data other than the development data (8.7%, 23/263). Only two-thirds of the papers (62.4%, 164/263) presented the model such that validation in other populations was possible, and the clinical applicability was discussed in only 11.0% (29/263). The impact of developed models on clinical practice was unknown. We identified a large number of prognostic models in obstetrics, but there is relatively little evidence about their performance, impact, and usefulness in clinical practice so that at this point, clinical implementation cannot be recommended. New efforts should be directed toward evaluating the performance and impact of the existing models.