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A systematic review of the status and methodological considerations for estimating risk of first ever stroke in the general population

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Abstract

Aims

The methodological quality of development, validation, and modification of those models have not been evaluated via a thoroughly literature review. This study aims to describe the overall status and evaluate the methodological quality of risk prediction models for stroke incidence in the general population.

Methods

We searched the database of EMBASE and MEDLINE by the combination of subject words and key words to collect the research on stroke risk prediction model in the general population. The retrieval time was from the establishment of the database to September 2019. It should be mentioned that risk of bias for each model was assessed, and data on population characteristics and model performance was also extracted.

Results

The search screened 11,386 peer-reviewed publications and 57 citation searching, of which 48 were included in the review, describing the development of 51 prediction models, 47 external validation models, and 12 modification models. Among 51 development models, the predicted outcome concentrated on fatal or non-fatal stroke (n = 37, 73%). Thirty-nine development models (76%) were without internal validation. C-statistic or AUC was adopted for discrimination in 80% models, and Hosmer-Lemeshow test (n = 25, 49%) was also performed for calibration. Twenty-six development models (53%) were externally validated, among which only 2 (8%) were validated by independent researchers. Risk prediction performance was improved when models were modified by adding novel risk factors, such as the internal carotid artery plaque and intima-media thickness.

Conclusion

Models for predicting stroke occurrence need further external validation, recalibration, or modification in different populations, to help interpret those models in the practice of stroke prevention.

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Acknowledgements

We would like to thank Huang Jiuyi for providing stroke clinical expertise in the critical appraisal of the included studies.

Funding

This research was supported by the National Natural Science Foundation of China (Grant No. 8187111615)

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  1. School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China

    Wei Xu, Qingsong Yu, Hongfan Yu, Yang Pu & Qiuling Shi

  2. Community Prevention Research Unit, Shanghai Institute of Cerebrovascular Disease Prevention, Shanghai, 201203, China

    Jiuyi Huang

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Xu, W., Huang, J., Yu, Q. et al. A systematic review of the status and methodological considerations for estimating risk of first ever stroke in the general population. Neurol Sci 42, 2235–2247 (2021). https://doi.org/10.1007/s10072-021-05219-w

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