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Gerdin M, Roy N, Felländer-Tsai L, Tomson G, von Schreeb J, Petzold M, Gupta A, Jhakal A, Basak D, Mohamed Ismail D, Yabo D, Jegadeesan K, Kamble J, Saha ML, Nitnaware M, Khajanchi M, Jothi R, Ghosh SN, Bhoi S, Mahindrakar S, Dharap S, Rao S, Kamal V, Kumar V, Tirlotkar S. Traumatic transfers: calibration is adversely affected when prediction models are transferred between trauma care contexts in India and the United States. J Clin Epidemiol 2016; 74:177-86. [PMID: 26775627 DOI: 10.1016/j.jclinepi.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/13/2015] [Accepted: 01/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We evaluated the transferability of prediction models between trauma care contexts in India and the United States and explored updating methods to adjust such models for new contexts. STUDY DESIGN AND SETTINGS Using a combination of prospective cohort and registry data from 3,728 patients of Towards Improved Trauma Care Outcomes in India (TITCO) and from 18,756 patients of the US National Trauma Data Bank (NTDB), we derived models in one context and validated them in the other, assessing them for discrimination and calibration using systolic blood pressure, heart rate, and Glasgow coma scale as candidate predictors. RESULTS Early mortality was 8% in the TITCO and 1-2% in the NTDB samples. Both models discriminated well, but the TITCO model overestimated the risk of mortality in NTDB patients, and the NTDB model underestimated the risk in TITCO patients. CONCLUSION Transferability was good in terms of discrimination but poor in terms of calibration. It was possible to improve this miscalibration by updating the models' intercept. This updating method could be used in samples with as few as 25 events.
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Affiliation(s)
- Martin Gerdin
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Nobhojit Roy
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra 400085, India; School of Habitat, Tata Institute of Social Sciences, Chembur, Mumbai, Maharashtra 400088, India
| | - Li Felländer-Tsai
- Division of Orthopedics and Biotechnology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Alfred Nobels allé 8, SE-141 52 Huddinge, Sweden
| | - Göran Tomson
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Johan von Schreeb
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Max Petzold
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, SE-405 30 Gothenburg, Sweden; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Johannesburg 2193, South Africa
| | | | - Amit Gupta
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Ashish Jhakal
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Debojit Basak
- Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Harish Mukherjee Rd, Bhowanipore, Kolkata, India
| | - Deen Mohamed Ismail
- Department of Orthopedics, Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Dusu Yabo
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - K Jegadeesan
- Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Jyoti Kamble
- King Edward Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Makhan Lal Saha
- Department of Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Harish Mukherjee Rd, Bhowanipore, Kolkata, India
| | - Mangesh Nitnaware
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra 400022, India
| | - Monty Khajanchi
- General Surgery, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Ranganathan Jothi
- Department of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Samarendra Nath Ghosh
- Department of Neurosurgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Harish Mukherjee Rd, Bhowanipore, Kolkata, India
| | - Sanjeev Bhoi
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Santosh Mahindrakar
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Satish Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra 400022, India
| | - Shilpa Rao
- Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Veera Kamal
- Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra 400022, India
| | - Santosh Tirlotkar
- School of Habitat, Tata Institute of Social Sciences, Chembur, Mumbai, Maharashtra 400088, India
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