孕产妇的早期预警得分在方法上很弱,并且存在偏差的高风险
Mae Chester-Jones1, Shona Kirtley1, Fema Er1
1Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
Journal of clinical epidemiology
|May 21, 2025
概括
大多数修改产科早期预警分数 (MOEWS) 缺乏严格的开发和验证. 糟糕的方法和高偏差风险表明临床实践中的潜在危害.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇健康 孕产妇健康
- 临床预测模型临床预测模型
背景情况:
- 修改产科早期预警分数 (MOEWS) 对于产科紧急情况的及时干预至关重要.
- 现有的MOEWS需要进行系统评估,以确保其可靠性和安全性.
研究的目的:
- 系统地审查和批判性地评估MOEWS的开发方法.
- 评估已发表的MOEWS研究中的方法质量和偏差风险.
主要方法:
- 搜索了MOEWS研究 (2000-2022) 的主要数据库 (Medline,CINAHL,EMBASE,科学网).
- 使用预测模型偏差风险评估工具 (PROBAST) 和TRIPOD指南进行评估的模型.
- 包括预测孕产妇死亡,ICU入院或严重发病率的研究.
主要成果:
- 包括20项研究;只有4项使用统计方法进行开发.
- 数据驱动的开发研究未能解决关键的统计问题 (例如,缺失的数据,重复测量).
- 95%的开发研究和73%的验证研究具有高偏差风险;没有一个独立验证.
结论:
- 显著缺乏根据推的统计准则开发的MOEWS.
- 方法上的缺陷和高偏差风险表明,已发表的MOEWS可能表现不佳或有害.
- 未来的研究必须解决安全临床实施的统计挑战和子组表现.
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