Prognosis and prognostic research: validating a prognostic model
BMJPublished 28 May 2009
Doug Altman, Yvonne Vergouwe, Patrick Royston, Karel G.M. Moons
Citations1,458
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TL;DR
Douglas Altman and colleagues describe how to validate models and discuss some of the problems that need to be solved to validate prognostic models.
Abstract
Prognostic models are of little clinical value unless they are shown to work in other samples. Douglas Altman and colleagues describe how to validate models and discuss some of the problems
Keywords
Medicine
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