Fahey Marion, Crayton Elise, Wolfe Charles, Douiri Abdel
Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
PLoS One. 2018 Jan 29;13(1):e0185402. doi: 10.1371/journal.pone.0185402. eCollection 2018.
We aim to identify and critically appraise clinical prediction models of mortality and function following ischaemic stroke.
Electronic databases, reference lists, citations were searched from inception to September 2015. Studies were selected for inclusion, according to pre-specified criteria and critically appraised by independent, blinded reviewers. The discrimination of the prediction models was measured by the area under the curve receiver operating characteristic curve or c-statistic in random effects meta-analysis. Heterogeneity was measured using I2. Appropriate appraisal tools and reporting guidelines were used in this review.
31395 references were screened, of which 109 articles were included in the review. These articles described 66 different predictive risk models. Appraisal identified poor methodological quality and a high risk of bias for most models. However, all models precede the development of reporting guidelines for prediction modelling studies. Generalisability of models could be improved, less than half of the included models have been externally validated(n = 27/66). 152 predictors of mortality and 192 predictors and functional outcome were identified. No studies assessing ability to improve patient outcome (model impact studies) were identified.
Further external validation and model impact studies to confirm the utility of existing models in supporting decision-making is required. Existing models have much potential. Those wishing to predict stroke outcome are advised to build on previous work, to update and adapt validated models to their specific contexts opposed to designing new ones.
我们旨在识别并严格评估缺血性中风后死亡率和功能的临床预测模型。
从数据库建立至2015年9月，检索电子数据库、参考文献列表及引用文献。根据预先设定的标准选择纳入研究，并由独立的、不知情的评审员进行严格评估。在随机效应荟萃分析中，预测模型的辨别力通过曲线下面积（受试者工作特征曲线或c统计量）来衡量。异质性使用I²进行测量。本综述使用了适当的评估工具和报告指南。
共筛选了31395篇参考文献，其中109篇文章纳入本综述。这些文章描述了66种不同的预测风险模型。评估发现大多数模型的方法学质量较差且存在较高的偏倚风险。然而，所有模型均先于预测模型研究报告指南的制定。模型的可推广性有待提高，纳入的模型中不到一半进行了外部验证（n = 27/66）。确定了152个死亡率预测因素以及192个预测因素和功能结局。未发现评估改善患者结局能力的研究（模型影响研究）。
需要进一步进行外部验证和模型影响研究，以确认现有模型在支持决策方面的效用。现有模型有很大潜力。建议那些希望预测中风结局的人在先前工作的基础上，更新并调整经过验证的模型以适应其特定情况，而不是设计新模型。
