Related Experiment Video
Updated: Sep 15, 2025

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
External validation, impact assessment and clinical utilization of clinical prediction models: a prospective cohort
Banafsheh Arshi1, Laura Elizabeth Cowley2, Eline Rijnhart3
1Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
Objectives:
We aimed to assess paths taken by clinical prediction models (CPMs) after development by quantifying external validation, impact assessment, and utilization in clinical practice.
Study Design And Setting:
We followed a random sample of 109 regression-based CPM development articles published between 1995 and 2020 by performing a forward citation search. We estimated 5- and 10-year probabilities of validation and impact assessment after development of CPMs using Kaplan-Meier analysis. In addition, we conducted a survey among the authors of the development articles to determine whether the CPMs had been used in clinical settings.
Results:
Eighteen (17%) CPM development articles reported a CPM that was externally validated after development. Five- and 10-year probabilities of validation were 0.13 (0.06-0.19) and 0.16 (0.08-0.23), respectively. Only 1 article had a CPM with impact assessment during follow-up (10-year probability: 0.01 [0-0.04]). Among the 34 (31%) articles with a survey response, 17 (50%) had CPMs that had been used in clinical practice, in a median of five sites (interquartile range: 1-347). Of these models, only 4 (24%) were externally validated, and none had undergone impact assessment.
Conclusion:
Despite evidence of utilization in clinical settings, few models are externally validated after development, and published impact assessment is scarce. To prevent compromising patient safety, it is crucial to intensify efforts to promote external validation and impact assessment of prediction models.
Related Concept Videos
Data Validation
Nursing assessment guides are generally based on holistic models rather than medical...
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Clinical Trials
There are four phases in a clinical trial. A phase one...
Introduction to Epidemiology
Sensitivity, Specificity, and Predicted Value
Sensitivity is the...
Observational Studies
There are three types of observational studies – Prospective, retrospective, and cross-sectional.
Prospective Study
Prospective studies, also known as longitudinal or cohort studies, are carried out by collecting future data from groups sharing similar characteristics. One...

