与操作特定计算器相比,NSQIP通用外科风险计算器的准确性
Mark E Cohen1, Yaoming Liu1, Bruce L Hall1,2
1From the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
概括
美国外科医生学院国家外科质量改进计划 (ACS NSQIP) 的通用风险计算器 (N-RC) 显示出比操作特定风险计算器 (OS-RCs) 更优异的性能. 这一发现表明,通用模型可能更准确,特别是对于不太常见的程序.
科学领域:
- 手术结果研究研究.
- 医疗信息学 医疗信息学
- 医学中的预测分析.
背景情况:
- 与通用风险计算器 (N-RCs) 相比,运营特定风险计算器 (OS-RCs) 往往是在假设更高的准确性的情况下开发的.
- OS-RCs的开发和维护成本可能无法通过预测准确度的边际改进来证明是合理的.
- 该ACS NSQIP N-RC作为一个基准的普遍风险预测工具.
研究的目的:
- 将ACS NSQIP N-RC的预测性能与特定操作风险计算器 (OS-RCs) 进行比较.
- 评估特定操作的预测因素是否进一步提高OS-RCs的准确性.
- 确定数据集大小与通用与操作特定模型的相对准确性之间的关系.
主要方法:
- 使用了5,020,713个NSQIP患者记录的大队列,其中80%用于培训,20%用于验证.
- 针对六个不同的操作组和14个结果,开发了OS-RC和带有操作特定预测指标的OS-RC (OSP-RC).
- 预测准确性被评估使用接收器操作特征曲线下的面积 (AUROC),精度回忆曲线下的面积 (AUPRC) 和霍斯默-莱梅斯P值.
主要成果:
- 与OS-RC相比,N-RC表现出明显更大的AUROC (P=0.002) 和AUPRC (P<0.001).
- 在N-RC,OS-RC和OSP-RC之间没有观察到其他统计学上显著的准确性差异.
- 在操作组样本大小和N-RC对OS-RC的性能优势之间发现了统计学上显著的反向关系,无论是AUROC (r=-0.278,P=0.014) 还是AUPRC (r=-0.425,P<0.001).
结论:
- 与常见假设相反,通用N-RC显示出比特定操作模型更高的预测准确度.
- 对于OS-RCs,依赖较小的数据集可能会限制它们与N-RC相比准确估计预测效应的能力.
- 虽然N-RC显示了优势,但这些差异的临床意义可能是可以忽略不计的.
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