Clinical Prediction Models for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review
Clinical Prediction Models for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review
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DOI：
10.1007/s12028-012-9792-z
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发表时间：
2013-02-01
影响因子：
3.5
通讯作者：
Macdonald, R. Loch
中科院分区：
文献类型：
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作者：
Jaja, Blessing N. R.;Cusimano, Michael D.;Macdonald, R. Loch
临床预测模型可以增强临床决策和研究。然而，在蛛网膜下腔出血（aSAH）的可用预测模型很少使用。我们评估了SAH预测模型的方法学有效性和主要预测因素的相关性，以确定潜在的可靠模型并指导未来的模型开发尝试。我们检索了1995年1月至2012年6月的EMBASE、MEDLINE和Web of Science数据库，以确定报告了aSAH死亡率和功能结局临床预测模型的研究。11项研究被识别出来，其中3项是从3期临床试验的数据集开发的模型，其他的是从单个医院的记录。中位患者样本量为340例（四分位距149-733）。使用的主要预测因子为年龄（n = 8）、Fisher分级（n = 6）、世界神经外科医生联合会分级（n = 5）、动脉瘤大小（n = 5）和Hunt和Hess分级（n = 3）。年龄一直是二分法。在36%的研究中，通过单变量分析对潜在的预测因子进行了预筛选。只有一项研究因模型乐观而受到惩罚。关于模型开发的细节通常描述不足，没有发表的研究提供外部验证。虽然aSAH的临床预测模型使用一些简单的预测因子，但模型存在大量的方法学问题，没有一个得到外部验证。这排除了将现有模型用于临床或研究目的。我们建议进一步研究以开发和验证可靠的aSAH临床预测模型。
Clinical prediction models can enhance clinical decision-making and research. However, available prediction models in aneurysmal subarachnoid hemorrhage (aSAH) are rarely used. We evaluated the methodological validity of SAH prediction models and the relevance of the main predictors to identify potentially reliable models and to guide future attempts at model development.We searched the EMBASE, MEDLINE, and Web of Science databases from January 1995 to June 2012 to identify studies that reported clinical prediction models for mortality and functional outcome in aSAH. Validated methods were used to minimize bias.Eleven studies were identified; 3 developed models from datasets of phase 3 clinical trials, the others from single hospital records. The median patient sample size was 340 (interquartile range 149-733). The main predictors used were age (n = 8), Fisher grade (n = 6), World Federation of Neurological Surgeons grade (n = 5), aneurysm size (n = 5), and Hunt and Hess grade (n = 3). Age was consistently dichotomized. Potential predictors were prescreened by univariate analysis in 36 % of studies. Only one study was penalized for model optimism. Details about model development were often insufficiently described and no published studies provided external validation.While clinical prediction models for aSAH use a few simple predictors, there are substantial methodological problems with the models and none have had external validation. This precludes the use of existing models for clinical or research purposes. We recommend further studies to develop and validate reliable clinical prediction models for aSAH.