Prognostic models in obstetrics: available, but far from applicable.

Area of Science:

• Obstetrics and Gynecology
• Medical Informatics
• Biostatistics

Background:

• Healthcare increasingly uses prognostic models for patient risk assessment.
• A growing number of prognostic models are published for maternal and fetal outcomes.
• Evaluating these models' clinical utility is crucial for effective healthcare planning.

Purpose of the Study:

• To systematically review prognostic models in obstetrics.
• To assess their development, validation, and potential clinical advantages.
• To provide recommendations for future model development and assessment in obstetrics.

Main Methods:

• Systematic literature search of MEDLINE up to July 2012.
• Identification and analysis of papers reporting prognostic models in obstetrics.
• Assessment of model performance measures, validation, and clinical applicability.

Main Results:

• 263 prognostic models for 40 outcomes were identified from 177 papers.
• Preeclampsia and preterm delivery were the most common predicted outcomes.
• Most models lacked adequate validation (8.7%), assessment of key performance measures (82.9%), and discussion of clinical applicability (11.0%).
• Newer models did not consistently outperform older ones.

Conclusions:

• A large number of obstetric prognostic models exist, but evidence of their performance and clinical utility is limited.
• Current models cannot be recommended for clinical implementation due to insufficient validation and impact data.
• Future research should focus on evaluating the performance and clinical impact of existing models.