Prediction Models Need Appropriate Internal, Internal-external, and External Validation

Overview

Journal J Clin Epidemiol

Publisher Elsevier

Specialty Public Health

Date 2015 May 19

PMID 25981519

Citations 376

Authors

Ewout W Steyerberg

Frank E Harrell Jr

Affiliations

Soon will be listed here.

Citing Articles

The diagnostic and prognostic capability of artificial intelligence in spinal cord injury: A systematic review.

Gill S, Subbiah Ponniah H, Giersztein S, Anantharaj R, Namireddy S, Killilea J Brain Spine. 2025; 5:104208.

PMID: 40027293 PMC: 11871462. DOI: 10.1016/j.bas.2025.104208.

Complete Blood Count and Monocyte Distribution Width-Based Machine Learning Algorithms for Sepsis Detection: Multicentric Development and External Validation Study.

Campagner A, Agnello L, Carobene A, Padoan A, Del Ben F, Locatelli M J Med Internet Res. 2025; 27:e55492.

PMID: 40009841 PMC: 11904381. DOI: 10.2196/55492.

Multi-Institutional MR-Derived Radiomics to Predict Post-Exenteration Disease Recurrence in Patients With T4 Rectal Cancer.

OSullivan N, Tohidinezhad F, Temperley H, Ajredini M, Sokmen B, Atabey R Cancer Med. 2025; 14(4):e70699.

PMID: 39967347 PMC: 11836347. DOI: 10.1002/cam4.70699.

Advancements in Artificial Intelligence for Kidney Transplantology: A Comprehensive Review of Current Applications and Predictive Models.

Mizera J, Pondel M, Kepinska M, Jerzak P, Banasik M J Clin Med. 2025; 14(3).

PMID: 39941645 PMC: 11818595. DOI: 10.3390/jcm14030975.

Instability of the AUROC of Clinical Prediction Models.

van Leeuwen F, Steyerberg E, van Klaveren D, Wessler B, Kent D, van Zwet E Stat Med. 2025; 44(5):e70011.

PMID: 39921554 PMC: 11806515. DOI: 10.1002/sim.70011.

References

Royston P, Parmar M, Sylvester R . Construction and validation of a prognostic model across several studies, with an application in superficial bladder cancer. Stat Med. 2004; 23(6):907-26. DOI: 10.1002/sim.1691. View

Austin P, Steyerberg E . Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models. Stat Methods Med Res. 2014; 26(2):796-808. PMC: 5394463. DOI: 10.1177/0962280214558972. View

Balmana J, Stockwell D, Steyerberg E, Stoffel E, Deffenbaugh A, Reid J . Prediction of MLH1 and MSH2 mutations in Lynch syndrome. JAMA. 2006; 296(12):1469-78. DOI: 10.1001/jama.296.12.1469. View

Steyerberg E, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh G . Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008; 5(8):e165. PMC: 2494563. DOI: 10.1371/journal.pmed.0050165. View

LeGrand C, Duchateau L, Janssen P, Ducrocq V, Sylvester R . Validation of prognostic indices using the frailty model. Lifetime Data Anal. 2008; 15(1):59-78. DOI: 10.1007/s10985-008-9092-2. View

Debray T, Vergouwe Y, Koffijberg H, Nieboer D, Steyerberg E, Moons K . A new framework to enhance the interpretation of external validation studies of clinical prediction models. J Clin Epidemiol. 2014; 68(3):279-89. DOI: 10.1016/j.jclinepi.2014.06.018. View

Steyerberg E, Bleeker S, Moll H, Grobbee D, Moons K . Internal and external validation of predictive models: a simulation study of bias and precision in small samples. J Clin Epidemiol. 2003; 56(5):441-7. DOI: 10.1016/s0895-4356(03)00047-7. View

Collins G, Reitsma J, Altman D, Moons K . Transparent reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement. J Clin Epidemiol. 2015; 68(2):134-43. DOI: 10.1016/j.jclinepi.2014.11.010. View

Martens F, Kers J, Janssens A . External validation is only needed when prediction models are worth it (Letter commenting on: J Clin Epidemiol. 2015;68:25-34). J Clin Epidemiol. 2015; 69:249-50. DOI: 10.1016/j.jclinepi.2015.01.022. View

10.

Steyerberg E, Harrell Jr F, Borsboom G, Eijkemans M, Vergouwe Y, Habbema J . Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001; 54(8):774-81. DOI: 10.1016/s0895-4356(01)00341-9. View

11.

Tugwell P, Knottnerus J . Clinical prediction models are not being validated. J Clin Epidemiol. 2014; 68(1):1-2. DOI: 10.1016/j.jclinepi.2014.11.020. View

12.

Justice A, Covinsky K, Berlin J . Assessing the generalizability of prognostic information. Ann Intern Med. 1999; 130(6):515-24. DOI: 10.7326/0003-4819-130-6-199903160-00016. View

13.

Siontis G, Tzoulaki I, Castaldi P, Ioannidis J . External validation of new risk prediction models is infrequent and reveals worse prognostic discrimination. J Clin Epidemiol. 2014; 68(1):25-34. DOI: 10.1016/j.jclinepi.2014.09.007. View

14.

Steyerberg E, Vergouwe Y . Towards better clinical prediction models: seven steps for development and an ABCD for validation. Eur Heart J. 2014; 35(29):1925-31. PMC: 4155437. DOI: 10.1093/eurheartj/ehu207. View

15.

Tugwell P, Knottnerus J . Transferability/generalizability deserves more attention in 'retest' studies in Diagnosis and Prognosis. J Clin Epidemiol. 2015; 68(3):235-6. DOI: 10.1016/j.jclinepi.2015.01.007. View

16.

Moons K, Altman D, Reitsma J, Ioannidis J, Macaskill P, Steyerberg E . Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015; 162(1):W1-73. DOI: 10.7326/M14-0698. View

17.

Siontis G, Ioannidis J . Response to letter by Forike et al.: more rigorous, not less, external validation is needed. J Clin Epidemiol. 2015; 69:250-1. DOI: 10.1016/j.jclinepi.2015.01.021. View