Cited by 286Statistical Methods in EpidemiologyArtificial Intelligence in HealthcareMeta-analysis and systematic reviews

The DOI matches its Crossref record; 56 of the 56 references it cites were found in a registry or an index.

There is no such thing as a validated prediction model

Open access
Van Calster, Ben, Steyerberg, Ewout W., Wynants, Laure, van Smeden, Maarten·2023·BMC Medicine

Abstract

BACKGROUND: Clinical prediction models should be validated before implementation in clinical practice. But is favorable performance at internal validation or one external validation sufficient to claim that a prediction model works well in the intended clinical context? MAIN BODY: We argue to the contrary because (1) patient populations vary, (2) measurement procedures vary, and (3) populations and measurements change over time. Hence, we have to expect heterogeneity in model performance between locations and settings, and across time. It follows that prediction models are never truly validated. This does not imply that validation is not important. Rather, the current focus on developing new models should shift to a focus on more extensive, well-conducted, and well-reported validation studies of promising models. CONCLUSION: Principled validation strategies are needed to understand and quantify heterogeneity, monitor performance over time, and update prediction models when appropriate. Such strategies will help to ensure that prediction models stay up-to-date and safe to support clinical decision-making.

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Crossref · 10.1186/s12916-023-02779-w

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Fig. 1 Distribution of patient age in the 9 largest centers from the ovarian cancer study. Histograms, density estimates, and mean (standard deviation) are given per center
Fig. 1 Distribution of patient age in the 9 largest centers from the ovarian cancer study. Histograms, density estimates, and mean (standard deviation) are given per centerCC BY · PubMed Central
Fig. 2 Distribution of maximum lesion diameter in the 9 largest centers from the ovarian cancer study. Histograms, density estimates, and median (interquartile range) are given per center
Fig. 2 Distribution of maximum lesion diameter in the 9 largest centers from the ovarian cancer study. Histograms, density estimates, and median (interquartile range) are given per centerCC BY · PubMed Central

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Metadata

Authors
Van Calster, B., Steyerberg, E. W., Wynants, L., & van Smeden, M.
Affiliations
  • KU Leuven (BE)
  • Maastricht University (NL)
Venue
BMC Medicine
Published
2023-02-24
Volume
21
Issue
1
Pages
70-70
ISSN
1741-7015 (ISSN-L)
OpenAlex
W4321782827
Cited by
286
References
56
Citations by year
2026: 99 · 2025: 91 · 2024: 67 · 2023: 29
FWCI
58.07
Type
journal article
Language
en
Open access
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Funders
Fonds Wetenschappelijk Onderzoek (G097322N)
Topics
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Keywords
clinical prediction model, model validation, external validation, internal validation, model updating, clinical decision support

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