Clinical Prediction Models in Children that Use Repeated Measurements with Time-Varying Covariates: A Scoping Review

Abstract

BackgroundEmerging evidence suggests that clinical prediction models that use repeated (time-varying) measurements within each patient may have higher predictive accuracy than models that use patient information from a single measurement. ObjectiveTo determine the breadth of the published literature reporting the development of clinical prediction models in children that use time-varying predictors. Data SourcesMEDLINE, EMBASE and Cochrane databases. Eligibility CriteriaWe included studies reporting the development of a multivariable clinical prediction model in children, with or without validation, to predict a repeatedly measured binary or time-to-event outcome and utilizing at least one repeatedly measured predictor. Synthesis MethodsWe categorized included studies by the method used to model time-varying predictors. ResultsOf 99 clinical prediction model studies that had a repeated measurements data structure, only 27 (27%) used methods that incorporated the repeated measurements as time-varying predictors in a single model. Among these 27 time-varying prediction model studies, we grouped model types into nine categories: time-dependent Cox regression, generalized estimating equations, random effects model, landmark model, joint model, neural network, K-nearest neighbor, support vector machine and tree-based algorithms. Where there was comparison of time-varying models to single measurement models, using time-varying predictors improved predictive accuracy. ConclusionsVarious methods have been used to develop time-varying prediction models in children, but there is a paucity of pediatric time-varying models in the literature. Incorporating time-varying covariates in pediatric prediction models may improve predictive accuracy. Future research in pediatric prediction model development should further investigate whether incorporation of time-varying covariates improves predictive accuracy. What this Scoping Review AddsOf 99 clinical prediction model studies that had a repeated measurements data structure, only 27% used analytical methods that incorporated time-varying covariates. Future research in pediatric prediction model development should further investigate whether incorporation of time-varying covariates improves predictive accuracy. How to Use this Scoping ReviewWe summarized methods used to develop pediatric clinical prediction models that incorporate repeated measurements with time-varying covariates. Researchers may use the findings of this review to identify appropriate analytical methods for developing a time-varying prediction model in pediatric care.