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Workup Bias in Prediction Research

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  • Robert J. Panzer
  • Anthony L. Suchman
  • Paul F. Griner

Abstract

Studies often suggest that accepted clinical predictors actually have little predictive strength. One explanation for some such results is the presence of workup bias. To explore the effects of workup bias in prediction research, the authors modeled the effects of workup bias on the ability of early clinical findings to predict intracerebral hemorrhage in patients with stroke. In a simulated biased sample, workup bias resulted in distorted operating characteristics for those clinical findings influencing application of the "gold standard" and for other related findings. Sensitivity was increased, but both specificity and likelihood ratios were decreased in the biased sample. Workup bias can spuriously decrease predictive abilities for accepted clinical findings when such findings guide application of the "gold standard." Investigators should be aware of the potential effects of workup bias, search for clues to its occurrence, and interpret study results carefully when it is present. Key words: workup bias; prediction rules; stroke; intracerebral hemorrhage. (Med Decis Making 7:115-119, 1987)

Suggested Citation

  • Robert J. Panzer & Anthony L. Suchman & Paul F. Griner, 1987. "Workup Bias in Prediction Research," Medical Decision Making, , vol. 7(2), pages 115-119, June.
    • Handle: RePEc:sae:medema:v:7:y:1987:i:2:p:115-119
    DOI: 10.1177/0272989X8700700209
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    References listed on IDEAS

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    1. Barbara J. McNeil & James A. Hanley, 1984. "Statistical Approaches to the Analysis of Receiver Operating Characteristic (ROC) Curves," Medical Decision Making, , vol. 4(2), pages 137-150, June.
    2. Robert Gray & Colin B. Begg & Robert A. Greenes, 1984. "Construction of Receiver Operating Characteristic Curves when Disease Verification Is Subject to Selection Bias," Medical Decision Making, , vol. 4(2), pages 151-164, June.
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    Cited by:

    1. George A. Diamond, 1987. "ROCky III," Medical Decision Making, , vol. 7(4), pages 247-249, December.

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