Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating (Statistics for Biology and Health)

This book provides insight and practical illustrations on how modern statistical concepts and regression methods can be applied in medical prediction problems, including diagnostic and prognostic outcomes. Many advances have been made in statistical approaches towards outcome prediction, but these innovations are insufficiently applied in medical research. Old-fashioned, data hungry methods are often used in data sets of limited size, validation of predictions is not done or done simplistically, and updating of previously developed models is not considered. A sensible strategy is needed for model development, validation, and updating, such that prediction models can better support medical practice. Clinical prediction models presents a practical checklist with seven steps that need to be considered for development of a valid prediction model. These include preliminary considerations such as dealing with missing values; coding of predictors; selection of main effects and interactions for a multivariable model; estimation of model parameters with shrinkage methods and incorporation of external data; evaluation of performance and usefulness; internal validation; and presentation formats. The steps are illustrated with many small case-studies and R code, with data sets made available in the public domain. The book further focuses on generalizability of prediction models, including patterns of invalidity that may be encountered in new settings, approaches to updating of a model, and comparisons of centers after case-mix adjustment by a prediction model. The text is primarily intended for clinical epidemiologists and biostatisticians. It can be used as a textbook for a graduate course on predictive modeling in diagnosis and prognosis. It is beneficial if readers are familiar with common statistical models in medicine: linear regression, logistic regression, and Cox regression. The book is practical in nature. But it provides a philosophical perspective on data analysis in medicine that goes beyond predictive modeling. In this era of evidence-based medicine, randomized clinical trials are the basis for assessment of treatment efficacy. Prediction models are key to individualizing diagnostic and treatment decision making. Ewout Steyerberg (1967) is Professor of Medical Decision Making, in particular prognostic modeling, at Erasmus MC–University Medical Center Rotterdam, the Netherlands. His work on prediction models was stimulated by various research grants including a fellowship from the Royal Netherlands Academy of Arts and Sciences. He has published over 250 peer-reviewed articles in collaboration with many clinical researchers, both in methodological and medical journals.

This book aims to provide insight and practical illustrations on how modern statistical concepts and regression methods can be applied in medical prediction problems, including diagnostic and prognostic outcomes. Many advances have been made in statistical approaches towards outcome prediction, but these innovations are insufficiently applied in medical research. Old-fashioned, data hungry methods are often used in data sets of limited size, validation of predictions is not done or only in a simplistic way, and updating of already available models is not considered. A sensible strategy is needed for model development, validation, and updating, such that prediction models can better support medical practice.

Clinical Prediction Models presents a practical checklist with seven steps that need to be considered for development of a valid prediction model. These include preliminary considerations such as dealing with missing values; coding of predictors; selection of main effects and interactions for a multivariable model; estimation of model parameters with shrinkage methods and incorporation of external data; evaluation of performance and clinical usefulness; internal validation; and presentation format. The steps are illustrated with many small case studies and R computer code, with data sets made available in the public domain [http://www.clinicalpredictionmodels.org/]. The book further focuses on generalizability of prediction models, including patterns of invalidity that may be encountered in new settings, approaches to modifying and extending a model, and comparisons of centers after case-mix adjustment by a prediction model.

The text is primarily intended for epidemiologists and applied biostatisticians. It can be used as a textbook for a graduate course on predictive modeling in diagnosis and prognosis. It is beneficial if readers are familiar with common statistical models in medicine: linear regression, logistic regression, and Cox regression. The book is practical in nature. But it also provides a philosophical perspective on data analysis in medicine that goes beyond predictive modeling. In this era of evidence-based medicine, randomized clinical trials are the basis for assessment of treatment efficacy. Prediction models are key to individualizing diagnostic and treatment decision-making.

A sensible strategy to all three aspects (development, validation, updating) is relevant to provide up-to-date prognostic models that can reliably support medical practice This book provides insight and practical illustrations on how modern statistical concepts and regression methods can be applied in medical prediction problems, including diagnostic and prognostic outcomes. Many advances have been made in statistical approaches towards outcome prediction, but these innovations are insufficiently applied in medical research. Old-fashioned, data hungry methods are often used in data sets of limited size, validation of predictions is not done or done simplistically, and updating of previously developed models is not considered. A sensible strategy is needed for model development, validation, and updating, such that prediction models can better support medical practice. Clinical prediction models presents a practical checklist with seven steps that need to be considered for development of a valid prediction model. These include preliminary considerations such as dealing with missing values; coding of predictors; selection of main effects and interactions for a multivariable model; estimation of model parameters with shrinkage methods and incorporation of external data; evaluation of performance and usefulness; internal validation; and presentation formats. The steps are illustrated with many small case-studies and R code, with data sets made available in the public domain. The book further focuses on generalizability of prediction models, including patterns of invalidity that may be encountered in new settings, approaches to updating of a model, and comparisons of centers after case-mix adjustment by a prediction model. The text is primarily intended for clinical epidemiologists and biostatisticians. It can be used as a textbook for a graduate course on predictive modeling in diagnosis and prognosis. It is beneficial if readers are familiar with common statisti Prediction models are important in various fields, including medicine, physics, meteorology, and finance. Prediction models will become more relevant in the medical field with the increase in knowledge on potential predictors of outcome, e.g. from genetics. Also, the number of applications will increase, e.g. with targeted early detection of disease, and individualized approaches to diagnostic testing and treatment. The current era of evidence-based medicine asks for an individualized approach to medical decision-making. Evidence-based medicine has a central place for meta-analysis to summarize results from randomized controlled trials; similarly prediction models may summarize the effects of predictors to provide individu- ized predictions of a diagnostic or prognostic outcome. Why Read This Book? My motivation for working on this book stems primarily from the fact that the development and applications of prediction models are often suboptimal in medical publications. With this book I hope to contribute to better understanding of relevant issues and give practical advice on better modelling strategies than are nowadays widely used. Issues include: (a) Better predictive modelling is sometimes easily possible; e.g. a large data set with high quality data is available, but all continuous predictors are dich- omized, which is known to have several disadvantages. Front Matter....Pages i-xxviii Introduction....Pages 1-7 Applications of prediction models....Pages 11-31 Study design for prediction models....Pages 33-52 Statistical Models for Prediction....Pages 53-82 Overfitting and optimism in prediction models....Pages 83-100 Choosing between alternative statistical models....Pages 101-111 Dealing with missing values....Pages 115-137 Case study on dealing with missing values....Pages 139-157 Coding of Categorical and Continuous Predictors....Pages 159-173 Restrictions on candidate predictors....Pages 175-189 Selection of main effects....Pages 191-211 Assumptions in regression models:Additivity and linearity....Pages 213-230 Modern estimation methods....Pages 231-242 Estimation with external information....Pages 243-254 Evaluation of performance....Pages 255-280 Clinical Usefulness....Pages 281-297 Validation of Prediction Models....Pages 299-311 Presentation formats....Pages 313-331 Patterns of external validity....Pages 335-360 Updating for a new setting....Pages 361-389 Updating for multiple settings....Pages 391-408 Prediction of a binary outcome:30-day mortality after acute myocardial infarction....Pages 411-426 Case study on survival analysis:prediction of secondary cardiovascular events....Pages 427-446 Lessons from case studies....Pages 447-462 Back Matter....Pages 463-497