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Article Dans Une Revue Intensive Care Medicine Année : 2014

How to derive and validate clinical prediction models for use in intensive care medicine

Résumé

BACKGROUND: Clinical prediction models are formal combinations of historical, physical examination and laboratory or radiographic test data elements designed to accurately estimate the probability that a specific illness is present (diagnostic model), will respond to a form of treatment (therapeutic model) or will have a well-defined outcome (prognostic model) in an individual patient. They are derived and validated using empirical data and used to assist physicians in their clinical decision-making that requires a quantitative assessment of diagnostic, therapeutic or prognostic probabilities at the bedside. PURPOSE: To provide intensivists with a comprehensive overview of the empirical development and testing phases that a clinical prediction model must satisfy before its implementation into clinical practice. RESULTS: The development of a clinical prediction model encompasses three consecutive phases, namely derivation, (external) validation and impact analysis. The derivation phase consists of building a multivariable model, estimating its apparent predictive performance in terms of both calibration and discrimination, and assessing the potential for statistical over-fitting using internal validation techniques (i.e. split-sampling, cross-validation or bootstrapping). External validation consists of testing the predictive performance of a model by assessing its calibration and discrimination in different but plausibly related patients. Impact analysis involves comparative research [i.e. (cluster) randomized trials] to determine whether clinical use of a prediction model affects physician practices, patient outcomes or the cost of healthcare delivery. CONCLUSIONS: This narrative review introduces a checklist of 19 items designed to help intensivists develop and transparently report valid clinical prediction models.
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Dates et versions

hal-02270846 , version 1 (26-08-2019)

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Jose Labarere, Renaud Bertrand, M.J. Fine. How to derive and validate clinical prediction models for use in intensive care medicine. Intensive Care Medicine, 2014, 40 (4), pp.513-527. ⟨10.1007/s00134-014-3227-6⟩. ⟨hal-02270846⟩
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