Chinese Evidence-based Medicine Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
J Clin Epidemiol. 2019 Nov;115:98-105. doi: 10.1016/j.jclinepi.2019.07.009. Epub 2019 Jul 18.
The objective of the study was to examine methodological characteristics about the design and conduct in prognostic prediction models used for obstetric care.
We searched PubMed for studies on prognostic prediction models for obstetric care, published in top general medicine or major specialty journals between January 2011 and February 2018. Teams of method-trained investigators independently screened titles and abstracts and collected data using a prespecified, pilot-tested, structured questionnaire.
In total, 91 studies were eligible, of which two were published in top general medicine journals, 20 (22.0%) involved an epidemiologist or statistician, 18 (19.4%) published study protocols, 53 (58.2%) did not include any model validation, 20 (22.0%) did not clearly state the intended timing of use, 23 (25.3%) had no eligibility criteria, 15 (16.5%) did not use clear criteria for ascertaining outcome, and 69 (75.82%) did not apply blinding to outcome assessment. Among those models, 11 (12.1%) included participants fewer than 200 events, 41 (48.8%) had fewer than 100 events, and 19 (24.7%) had fewer than 10 events per variable.
The prognostic prediction models have important limitations in design and conduct. Substantial efforts are needed to strengthen the production of reliable prognostic prediction models for obstetric care.
本研究旨在考察产科护理预后预测模型的设计和实施中的方法学特征。
我们在 PubMed 上检索了 2011 年 1 月至 2018 年 2 月期间发表在顶级普通医学或主要专业期刊上的产科护理预后预测模型研究。经过方法培训的调查人员团队使用预先确定的、经过试验验证的结构化问卷独立筛选标题和摘要并收集数据。
共有 91 项研究符合条件，其中两项发表在顶级普通医学期刊上，20 项（22.0%）涉及流行病学家或统计学家，18 项（19.4%）发表了研究方案，53 项（58.2%）没有进行任何模型验证，20 项（22.0%）没有明确说明预期使用时间，23 项（25.3%）没有纳入标准，15 项（16.5%）没有明确确定结局的标准，69 项（75.82%）没有对结局评估进行盲法。在这些模型中，11 项（12.1%）纳入的参与者少于 200 例事件，41 项（48.8%）纳入的参与者少于 100 例事件，19 项（24.7%）纳入的参与者每变量少于 10 例事件。
预后预测模型在设计和实施方面存在重要局限性。需要做出巨大努力来加强产科护理可靠预后预测模型的产生。
