Validation, updating and impact of clinical prediction rules: A review

Toll, D. B.; Janssen, Kristel J.M.; Vergouwe, Yvonne; Moons, Karel G.M.

doi:10.1016/j.jclinepi.2008.04.008

Cited by 483 publications

(502 citation statements)

References 60 publications

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“…Given the changes in recommended immunosuppressive therapy over this time frame but tempered by their recognized potential for toxicity, the assessment of their effect on long-term outcome remains a crucial element in MGN management. Implementation studies are rarely performed in clinical research but are the final demonstration that a proposed treatment has changed outcome in the everyday setting (15).…”

Section: Introductionmentioning

confidence: 99%

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

Cattran

Reich

Kim

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The long-term effect of immunosuppressive therapy (IS) on kidney survival in idiopathic membranous nephropathy (MGN) is debated. The introduction of renin angiotensin blockade, rigorous BP control, and the increasing age at presentation of patients with MGN adds further uncertainty. Given these important changes, we sought to determine whether implementation of IS has altered outcome. Design, setting, participants, & methodsWe prospectively evaluated 280 incident MGN patients from three distinct 10-year periods starting from 1975. ResultsWe found expected changes in treatment regimens but also variations in age, renal function, severity of proteinuria, and BP at presentation over this time. Outcomes did not differ over time if these significant variations in clinical characteristics were not accounted for across the eras. The effect of IS in the 57 patients treated with currently recommended regimens was assessed using propensity adjustment to address selection bias and the effect of newer, conservative therapies. A propensity score estimating the probability of receiving IS permitted the pairing of 39 treated patients with controls with similar high risk of progression of clinical features. Using this approach, IS was associated not only with remissions in proteinuria but also with substantially improved renal survival. ConclusionsThe study confirms that patient presenting characteristics and management regimens have changed significantly over time and the natural history of MGN has been altered. A study of propensitymatched patients confirms that current recommendations for IS have improved outcomes in MGN patients at high risk of progression.

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Section: Introductionmentioning

confidence: 99%

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

Cattran

Reich

Kim

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Several authors have provided hierarchical frameworks for validation strategies. 12,16,17 Although these frameworks differ in detail, all authors agreed that confirmatory results provide stronger evidence for the generalisability of a CPR if the individual studies differed in some aspects, for example, if different inclusion criteria were used, if different physicians participated, or if the studies were conducted in different countries, or within different healthcare systems.…”

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confidence: 99%

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Haasenritter¹,

Bösner²,

Vaucher³

et al. 2012

Br J Gen Pract

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BackgroundThe Marburg Heart Score (MHS) aims to assist GPs in safely ruling out coronary heart disease (CHD) in patients presenting with chest pain, and to guide management decisions. AimTo investigate the diagnostic accuracy of the MHS in an independent sample and to evaluate the generalisability to new patients. Design and settingCross-sectional diagnostic study with delayedtype reference standard in general practice in Hesse, Germany. MethodFifty-six German GPs recruited 844 males and females aged ≥35 years, presenting between July 2009 and February 2010 with chest pain. Baseline data included the items of the MHS. Data on the subsequent course of chest pain, investigations, hospitalisations, and medication were collected over 6 months and were reviewed by an independent expert panel. CHD was the reference condition. Measures of diagnostic accuracy included the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and predictive values. ResultsThe AUC was 0.84 (95% confidence interval [CI] = 0.80 to 0.88). For a cut-off value of 3, the MHS showed a sensitivity of 89.1% (95% CI = 81.1% to 94.0%), a specificity of 63.5% (95% CI = 60.0% to 66.9%), a positive predictive value of 23.3% (95% CI = 19.2% to 28.0%), and a negative predictive value of 97.9% (95% CI = 96.2% to 98.9%). ConclusionConsidering the diagnostic accuracy of the MHS, its generalisability, and ease of application, its use in clinical practice is recommended.Keywords chest pain; medical history taking; myocardial ischaemia; sensitivity and specificity.

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“…It has been emphasized repeatedly that a validation study should consist of an adequate sample of different but related patients compared with the derivation population (5). "Relatedness" is defined by patients at risk for the same event.…”

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confidence: 99%

“…Validation studies typically include fewer patients and are expected to show a similar signal compared with the original study without necessarily duplicating every result (5). Two additional features here may have influenced statistical power.…”

mentioning

confidence: 99%