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A guide to systematic review and meta-analysis of prediction model performance
Open accessAbstract
Validation of prediction models is highly recommended and increasingly common in the literature. A systematic review of validation studies is therefore helpful, with meta-analysis needed to summarise the predictive performance of the model being validated across different settings and populations. This article provides guidance for researchers systematically reviewing and meta-analysing the existing evidence on a specific prediction model, discusses good practice when quantitatively summarising the predictive performance of the model across studies, and provides recommendations for interpreting meta-analysis estimates of model performance. We present key steps of the meta-analysis and illustrate each step in an example review, by summarising the discrimination and calibration performance of the EuroSCORE for predicting operative mortality in patients undergoing coronary artery bypass grafting.
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“These methods mainly focused on (diagnostic) prediction models with a binary outcome, and may therefore have limited value when reviewing (prognostic) models with a time-to-event outcome.”
From A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes (2019) · cites this paper as [14]
In the citing paper
“In particular, the total O:E ratio quantifies the averaged observed:expected ratio across the entire range of predicted risks, and is strongly related to calibration-in-the-large.14”
From A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes (2019) · cites this paper as [14]
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“In particular, discrimination and calibration performance are highly dependent on patient spectrum (case-mix variation) and therefore most likely to vary across validation studies.14”
From A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes (2019) · cites this paper as [14]
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“However, it is common for validation studies to present information on the total number of observed (O) and expected (E) events, or the corresponding observed frequencies PO and PE. These quantities can then be used to calculate the total O:E ratio”
From A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes (2019) · cites this paper as [14]
In the citing paper
“Quantitative synthesis of prediction model studies may help to better understand their potential generalizability and can be achieved by applying meta-analysis methods.14”
From A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes (2019) · cites this paper as [14]
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Self-citation
Metadata
- Authors
- Debray, T. P. A., Damen, J. A. A. G., Snell, K. I. E., Ensor, J., Hooft, L., Reitsma, J. B., Riley, R. D., & Moons, K. G. M.
- Affiliations
- University Medical Center Utrecht (NL)
- Keele University (GB)
- Corresponding author
- Debray, Thomas P A
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2017-01-05
- Volume
- 356
- Pages
- i6460
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W2570878489
- Cited by
- 657
- References
- 48
- Citations by year
- 2026: 109 · 2025: 98 · 2024: 94 · 2023: 81 · 2022: 64 · 2021: 82 · 2020: 56 · 2019: 33 · 2018: 27 · 2017: 11
- FWCI
- 8.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Medical Research Council (MR/L004933/1, G0902393)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- prediction model validation, systematic reviews, meta-analysis, predictive performance, discrimination (statistics), calibration, EuroSCORE, postoperative mortality, coronary artery bypass grafting, risk prediction model
- MeSH terms
- Systematic Reviews as Topic, Coronary Artery Bypass, Decision Support Techniques, Humans, Meta-Analysis as Topic, Risk Assessment, Validation Studies as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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