Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods
Abstract Background Pressure injuries (PIs) place a substantial burden on healthcare systems worldwide. Risk stratification of those who are at risk of developing PIs allows preventive interventions to be focused on patients who are at the highest risk. The considerable number of risk assessment sca...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | Diagnostic and Prognostic Research |
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| Online Access: | https://doi.org/10.1186/s41512-024-00182-4 |
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| author | Bethany Hillier Katie Scandrett April Coombe Tina Hernandez-Boussard Ewout Steyerberg Yemisi Takwoingi Vladica Velickovic Jacqueline Dinnes |
| author_facet | Bethany Hillier Katie Scandrett April Coombe Tina Hernandez-Boussard Ewout Steyerberg Yemisi Takwoingi Vladica Velickovic Jacqueline Dinnes |
| author_sort | Bethany Hillier |
| collection | DOAJ |
| description | Abstract Background Pressure injuries (PIs) place a substantial burden on healthcare systems worldwide. Risk stratification of those who are at risk of developing PIs allows preventive interventions to be focused on patients who are at the highest risk. The considerable number of risk assessment scales and prediction models available underscores the need for a thorough evaluation of their development, validation, and clinical utility. Our objectives were to identify and describe available risk prediction tools for PI occurrence, their content and the development and validation methods used. Methods The umbrella review was conducted according to Cochrane guidance. MEDLINE, Embase, CINAHL, EPISTEMONIKOS, Google Scholar, and reference lists were searched to identify relevant systematic reviews. The risk of bias was assessed using adapted AMSTAR-2 criteria. Results were described narratively. All included reviews contributed to building a comprehensive list of risk prediction tools. Results We identified 32 eligible systematic reviews only seven of which described the development and validation of risk prediction tools for PI. Nineteen reviews assessed the prognostic accuracy of the tools and 11 assessed clinical effectiveness. Of the seven reviews reporting model development and validation, six included only machine learning models. Two reviews included external validations of models, although only one review reported any details on external validation methods or results. This was also the only review to report measures of both discrimination and calibration. Five reviews presented measures of discrimination, such as the area under the curve (AUC), sensitivities, specificities, F1 scores, and G-means. For the four reviews that assessed the risk of bias assessment using the PROBAST tool, all models but one were found to be at high or unclear risk of bias. Conclusions Available tools do not meet current standards for the development or reporting of risk prediction models. The majority of tools have not been externally validated. Standardised and rigorous approaches to risk prediction model development and validation are needed. Trial registration The protocol was registered on the Open Science Framework ( https://osf.io/tepyk ). |
| format | Article |
| id | doaj-art-19240dfeb8114e5b9e3791df01d5f06c |
| institution | Kabale University |
| issn | 2397-7523 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Diagnostic and Prognostic Research |
| spelling | doaj-art-19240dfeb8114e5b9e3791df01d5f06c2025-01-19T12:43:02ZengBMCDiagnostic and Prognostic Research2397-75232025-01-019111910.1186/s41512-024-00182-4Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methodsBethany Hillier0Katie Scandrett1April Coombe2Tina Hernandez-Boussard3Ewout Steyerberg4Yemisi Takwoingi5Vladica Velickovic6Jacqueline Dinnes7Department of Applied Health Sciences, College of Medicine and Health, University of BirminghamDepartment of Applied Health Sciences, College of Medicine and Health, University of BirminghamDepartment of Applied Health Sciences, College of Medicine and Health, University of BirminghamDepartment of Medicine, Stanford UniversityDepartment of Biomedical Data Sciences, Leiden University Medical CenterDepartment of Applied Health Sciences, College of Medicine and Health, University of BirminghamEvidence Generation Department, HARTMANN GROUPDepartment of Applied Health Sciences, College of Medicine and Health, University of BirminghamAbstract Background Pressure injuries (PIs) place a substantial burden on healthcare systems worldwide. Risk stratification of those who are at risk of developing PIs allows preventive interventions to be focused on patients who are at the highest risk. The considerable number of risk assessment scales and prediction models available underscores the need for a thorough evaluation of their development, validation, and clinical utility. Our objectives were to identify and describe available risk prediction tools for PI occurrence, their content and the development and validation methods used. Methods The umbrella review was conducted according to Cochrane guidance. MEDLINE, Embase, CINAHL, EPISTEMONIKOS, Google Scholar, and reference lists were searched to identify relevant systematic reviews. The risk of bias was assessed using adapted AMSTAR-2 criteria. Results were described narratively. All included reviews contributed to building a comprehensive list of risk prediction tools. Results We identified 32 eligible systematic reviews only seven of which described the development and validation of risk prediction tools for PI. Nineteen reviews assessed the prognostic accuracy of the tools and 11 assessed clinical effectiveness. Of the seven reviews reporting model development and validation, six included only machine learning models. Two reviews included external validations of models, although only one review reported any details on external validation methods or results. This was also the only review to report measures of both discrimination and calibration. Five reviews presented measures of discrimination, such as the area under the curve (AUC), sensitivities, specificities, F1 scores, and G-means. For the four reviews that assessed the risk of bias assessment using the PROBAST tool, all models but one were found to be at high or unclear risk of bias. Conclusions Available tools do not meet current standards for the development or reporting of risk prediction models. The majority of tools have not been externally validated. Standardised and rigorous approaches to risk prediction model development and validation are needed. Trial registration The protocol was registered on the Open Science Framework ( https://osf.io/tepyk ).https://doi.org/10.1186/s41512-024-00182-4DevelopmentInternalExternal validationPredictionPrognosticPressure injury |
| spellingShingle | Bethany Hillier Katie Scandrett April Coombe Tina Hernandez-Boussard Ewout Steyerberg Yemisi Takwoingi Vladica Velickovic Jacqueline Dinnes Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods Diagnostic and Prognostic Research Development Internal External validation Prediction Prognostic Pressure injury |
| title | Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods |
| title_full | Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods |
| title_fullStr | Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods |
| title_full_unstemmed | Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods |
| title_short | Risk prediction tools for pressure injury occurrence: an umbrella review of systematic reviews reporting model development and validation methods |
| title_sort | risk prediction tools for pressure injury occurrence an umbrella review of systematic reviews reporting model development and validation methods |
| topic | Development Internal External validation Prediction Prognostic Pressure injury |
| url | https://doi.org/10.1186/s41512-024-00182-4 |
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