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Should we use composite outcomes in obstetric clinical prediction models?
Holly J Giles-Clark1, Sasha M Skinner1, Daniel L Rolnik1
1Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
Summary
Composite outcomes in obstetric prediction models can mislead clinicians. Careful use or avoidance of these combined endpoints is recommended to ensure accurate prognostic model development and reporting.
Area of Science:
- Obstetrics
- Clinical Epidemiology
- Biostatistics
Background:
- Clinical prediction models aid in estimating disease progression and guiding treatment decisions.
- Composite outcomes are frequently used in obstetric prediction models to enhance statistical power for rare events.
- Existing literature primarily discusses composite outcomes in clinical trials, with limited focus on prognostic model development.
Purpose of the Study:
- To review the implications of using composite outcomes in the development and reporting of obstetric prognostic models.
- To highlight potential misleading conclusions arising from unequal predictor-component outcome relationships.
- To propose recommendations for the use of composite outcomes in obstetric prognostic modeling.
Main Methods:
- Literature review and critical analysis of the use of composite outcomes in prognostic model development.
- Examination of how composite outcomes can obscure important predictors or lead to inappropriate clinical decisions.
- Discussion of methodological standards and reporting practices.
Main Results:
- Unequal relationships between predictors and individual component outcomes can lead to misleading conclusions.
- The use of composite outcomes may result in the omission of rare but significant predictors.
- Composite outcomes can inappropriately inform clinical intervention decisions.
Conclusions:
- Proposes careful use or avoidance of composite outcomes in obstetric prognostic model development.
- Recommends updating methodological standards to standardize and appraise composite outcomes.
- Supports reporting on component outcome accuracy and predictor variable inconsistencies.
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