scholarly journals Novel approach to meta-analysis of tests and clinical prediction rules with three or more risk categories

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e036262
Author(s):  
Mark H Ebell ◽  
Mary E Walsh ◽  
Fiona Boland ◽  
Brian McKay ◽  
Tom Fahey
Keyword(s):  
Clinical Decision Making ◽  
Risk Group ◽  
Meta Analysis ◽  
Cancer Recurrence ◽  
Clinical Prediction ◽  
Likelihood Ratios ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Novel Approach ◽  
Risk Categories

ObjectiveMultichotomous tests have three or more outcome or risk categories, and can provide richer information and a better fit with clinical decision-making than dichotomous tests. Our objective is to present a fully developed approach to the meta-analysis of multichotomous clinical prediction rules (CPRs) and tests, including meta-analysis of stratum specific likelihood ratios.Study designWe have developed a novel approach to the meta-analysis of likelihood ratios for multichotomous tests that avoids the need to dichotomise outcome categories, and demonstrate its application to a sample CPR. We also review previously reported approaches to the meta-analysis of the area under the receiver operating characteristic curve (AUROCC) and meta-analysis of a measure of calibration (observed:expected) for multichotomous tests or CPRs.ResultsUsing data from 10 studies of the Cancer of the Prostate Risk Assessment (CAPRA) risk score for prostate cancer recurrence, we calculated summary estimates of the likelihood ratios for low, moderate and high risk groups of 0.40 (95% CI 0.32 to 0.49), 1.24 (95% CI 0.99 to 1.55) and 4.47 (95% CI 3.21 to 6.23), respectively. Applying the summary estimates of the likelihood ratios for each risk group to the overall prevalence of cancer recurrence in a population allows one to estimate the likelihood of recurrence for each risk group in that population.ConclusionAn approach to meta-analysis of multichotomous tests or CPRs is presented. A spreadsheet for data preparation and code for R and Stata are provided for other researchers to download and use. Combined with summary estimates of the AUROCC and calibration, this is a comprehensive strategy for meta-analysis of multichotomous tests and CPRs.

C0302 Prognostic clinical prediction rules to identify low-risk pulmonary embolism: A systematic review and meta-analysis

2012 ◽  
Vol 130 ◽  
pp. S125
Author(s):  
Alessandro Squizzato ◽  
Marco P. Donadini ◽  
Luca Galli ◽  
Francesco Dentali ◽  
Drahomir Aujesky ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Low Risk ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules

scholarly journals Understanding general practitioners’ views and experiences of using clinical prediction rules in the management of respiratory infections: a qualitative study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0096
Author(s):  
Hilda O Hounkpatin ◽  
Catherine Woods ◽  
Mark Lown ◽  
Beth Stuart ◽  
Geraldine M Leydon
Keyword(s):  
Public Involvement ◽  
Clinical Decision Making ◽  
Respiratory Infections ◽  
Clinical Decision ◽  
Routine Practice ◽  
Antibiotic Prescribing ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Tract Infections

Background:Respiratory tract infections (RTIs) account for 60% of antibiotic prescribing in primary care. Several clinical prediction rules (CPRs) have been developed to help reduce unnecessary prescribing for RTIs, but there are a lack of studies exploring whether or how these CPRs are being used in UK general practice.Aim:To explore UK GPs’ views and experiences with regards to RTI CPRs and to identify barriers and facilitators to their use in practice.Design & setting:A qualitative analysis of interviews with in-hours GPs working in the South and South West of England.Method:Semi-structured qualitative telephone interviews were conducted, digitally recorded, transcribed verbatim and analysed using an inductive thematic approach. Patient and public involvement representatives contributed to study design and interpretation of findings.Results:Thirty-two GPs were interviewed. Some CPRs were more commonly used than others. Participants used CPRs to facilitate patient-clinician discussion, confirm and support their decision, and document the consultation. GPs also highlighted concerns including lack of time, inability of CPRs to incorporate patient complexity, a shift in focus from the patient during consultations, and limited use in remote consultation (during the COVID-19 pandemic).Conclusion:This study highlights the need for user-friendly CPRs that are readily integrated into computer systems, and easily embedded into routine practice to complement clinical decision making. Existing CPRs need to be validated for other populations where demographics and clinical characteristics may differ as well different settings including remote consultations and self-assessment.

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