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Related Experiment Videos

Identifying confounding by indication through blinded prospective review.

S C Johnston1

  • 1Neurovascular Service, Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0114, USA. clayj@itsa.ucsf.edu

American Journal of Epidemiology
|August 2, 2001
PubMed
Summary

Confounding by indication poses a significant challenge in observational studies. A blinded prospective review of cerebral aneurysm cases demonstrated reproducible practitioner judgments that improved risk assessment beyond traditional multivariable models.

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Area of Science:

  • Neurosurgery
  • Medical Informatics
  • Epidemiology

Background:

  • Observational studies assessing treatment efficacy face confounding by indication.
  • Multivariable models may not fully capture perceived treatment risk or patient prognosis.
  • Accurate risk assessment is crucial for valid treatment effect evaluation.

Purpose of the Study:

  • To develop and validate a method for incorporating practitioner judgment into observational studies of cerebral aneurysm treatments.
  • To assess whether perceived prognosis improves upon existing multivariable models in predicting outcomes.
  • To mitigate confounding by indication in treatment effect studies.

Main Methods:

  • Patient data and images from 179 cerebral aneurysm cases were presented to blinded practitioner panels.

Related Experiment Videos

  • Practitioners provided judgments on treatment indication and preprocedural prognosis.
  • These judgments were used to stratify and adjust analyses of treatment modality and outcome.

    • Main Results:

    • Practitioner judgments regarding prognosis were reproducible.
    • Perceived prognosis correlated with complication rates.
    • Perceived prognosis provided additional predictive information not captured by multivariable models.

    Conclusions:

    • Blinded prospective review offers a robust method to define comparable cohorts in observational studies.
    • This approach allows for measurement and adjustment of perceived procedural risk, enhancing study validity.
    • Incorporating clinical judgment can improve the accuracy of observational treatment effect studies.