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评估预测模型的充分性
Abhaya Indrayan1, Sakshi Mishra1
1Department of Clinical Research, Max Healthcare, New Delhi, India.
概括
由于准确性不足,许多预测模型缺乏实际采用. 对20篇论文的审查揭示了不充分的绩效评估方法,阻碍了可靠的结果预测.
科学领域:
- 生物统计学 生物统计学
- 临床流行病学临床流行病学
- 医疗信息学 医疗信息学
背景情况:
- 许多预测模型被开发出来,声称具有很高的准确性.
- 然而,模型开发和现实世界的临床采用之间存在很大的差距.
- 这种差异往往归因于实践中预测性能不足.
研究的目的:
- 批判性地评估用于评估最近发表的预测模型中的预测性能的方法.
- 在绩效指标和验证策略中识别常见的不足.
- 为开发具有足够预测准确度的模型提出补救措施,用于临床使用.
主要方法:
- 对最近发表的20篇关于预测模型的论文进行系统分析.
- 评估用于评估模型性能的统计措施,包括歧视和预测性.
- 评估验证设置和考虑结果的过程.
主要成果:
- 大多数分析的论文在评估预测性表现方面采用了不充分的措施.
- 通常使用的指标,如ROC曲线下的面积 (C指数),主要衡量歧视,而不是预测性.
- 总体一致性经常被使用,而不是基于个人的协议,诸如任意评分和误解P值等问题普遍存在.
结论:
- 当前评估预测模型的实践往往导致对其临床实用性的高估.
- 在评估预测准确性方面,急需改进方法,重点关注基于个体的协议和适当的验证.
- 采用更严格的评估标准将促进在医疗保健中开发和采用可靠的预测模型.
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