title: Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study.
abstract: BACKGROUND
  Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical prediction models for BPD.
  
  
  METHODS
  We searched the main electronic databases and abstracts from annual meetings. The STROBE instrument was used to assess the methodological quality. External validation of the retrieved models was performed using an individual patient dataset of 3229 patients at risk for BPD. Receiver operating characteristic curves were used to assess discrimination for each model by calculating the area under the curve (AUC). Calibration was assessed for the best discriminating models by visually comparing predicted and observed BPD probabilities.
  
  
  RESULTS
  We identified 26 clinical prediction models for BPD. Although the STROBE instrument judged the quality from moderate to excellent, only four models utilised external validation and none presented calibration of the predictive value. For 19 prediction models with variables matched to our dataset, the AUCs ranged from 0.50 to 0.76 for the outcome BPD. Only two of the five best discriminating models showed good calibration.
  
  
  CONCLUSIONS
  External validation demonstrates that, except for two promising models, most existing clinical prediction models are poor to moderate predictors for BPD. To improve the predictive accuracy and identify preterm infants for future intervention studies aiming to reduce the risk of BPD, additional variables are required. Subsequently, that model should be externally validated using a proper impact analysis before its clinical implementation.
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands. w.onland@amc.uva.nl.
authors.forename: Wes
authors.initials: W
authors.lastname: Onland
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Debray
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Laughon
authors.forename: Martijn
authors.initials: M
authors.lastname: Miedema
authors.forename: Filip
authors.initials: F
authors.lastname: Cools
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Askie
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Asselin
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Calvert
authors.forename: Sherry E
authors.initials: SE
authors.lastname: Courtney
authors.forename: Carlo
authors.initials: C
authors.lastname: Dani
authors.forename: David J
authors.initials: DJ
authors.lastname: Durand
authors.forename: Neil
authors.initials: N
authors.lastname: Marlow
authors.forename: Janet L
authors.initials: JL
authors.lastname: Peacock
authors.forename: J Jane
authors.initials: JJ
authors.lastname: Pillow
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Thome
authors.forename: Patrick
authors.initials: P
authors.lastname: Truffert
authors.forename: Michael D
authors.initials: MD
authors.lastname: Schreiber
authors.forename: Patrick
authors.initials: P
authors.lastname: Van Reempts
authors.forename: Valentina
authors.initials: V
authors.lastname: Vendettuoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vento
authors.forename: Anton H
authors.initials: AH
authors.lastname: van Kaam
authors.forename: Karel G
authors.initials: KG
authors.lastname: Moons
authors.forename: Martin
authors.initials: M
authors.lastname: Offringa
mesh_terms: D019540:Area Under Curve; D015982:Bias; D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002138:Calibration; D004231:Diuresis; D042241:Early Diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000628:therapy; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008962:Models, Theoretical; D064887:Observational Studies as Topic; D011237:Predictive Value of Tests; D012372:ROC Curve; D015431:Weight Loss