AI Article Synopsis
- This study examines referral bias in prognostic research for infective endocarditis by comparing characteristics and outcomes of patients from different hospital admission types.
- It analyzed data from 497 patients, categorizing them into three groups based on how they were admitted to hospitals: directly to a tertiary hospital, referred from a non-tertiary hospital, or admitted to a non-tertiary hospital.
- The findings revealed significant differences in patient demographics, surgical needs, and survival rates among the groups, indicating that referral bias can impact the accuracy of clinical characteristics and prognostic estimates.
Article Abstract
Purpose: Prognostic studies derived from samples of patients managed in tertiary hospitals are subject to referral bias. We aimed to characterize this bias using the example of infective endocarditis.
Methods: We analyzed data from a French population-based cohort, which included 497 patients with infective endocarditis. Patients were admitted directly to a tertiary hospital (Group T), admitted to a non-tertiary hospital and referred to a tertiary hospital (Group NTT) or not (Group NT). We compared patients' characteristics, survival rates and prognostic factors between groups.
Results: Compared with Group T (n = 291), NTT patients (n = 144) were more often males (81.3% vs. 72.5%; P = .046), injection drug users (9.7% vs. 4.5%; P = .033), and had more frequent surgical indications (78.5% vs. 64.3%; P = .003). Compared with Group NT (n = 62), NTT patients were more often males (81.3% vs. 67.7%; P = .034) and had surgical indications more often (78.5% vs. 19.4%; P < .001). One-year survival was higher in NTT + T patients than in NT patients (73.0% vs. 56.1%; P = .01). Prognostic factors and hazard ratios estimates varied across groups.
Conclusions: When derived from samples mixing patients admitted directly and those referred to tertiary hospitals, validity of characteristics description, survival estimates, and hazard ratios is threatened by referral bias.
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| http://dx.doi.org/10.1016/j.annepidem.2020.09.008 | DOI Listing |
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