International Journal of Molecular Medical Science, 2025, Vol.15, No.2, 54-68 http://medscipublisher.com/index.php/ijmms 56 Exclusion criteria: ①Non-Chinese or English language literature; ②Studies that have not established risk prediction models; ③Repetitive publications, such as those published in both conferences and journals; ④ Incomplete data, such as missing methods for constructing models or lack of outcome indicator data. 2.3 Literature screening and data extraction Two researchers independently conducted literature screening and data extraction, cross-checked each other. Initially, duplicate literature was removed, then preliminary screening was done based on the title and abstract of the literature, finally, inclusion and exclusion criteria were introduced to evaluate and extract data from the full text. If there were any disagreements between the two researchers in the literature screening, a third researcher would be involved in the discussion to reach a consensus. The extracted data information includes the author, publication year, research design, study population, data source, sample size, variable selection method, model development method, model validation type, model performance measure, handling of missing data, and treatment method for continuous variables. 2.4 Quality evaluation The two researchers will independently assess the risk of bias in the studies included using the PROBAST tool (Wolff et al., 2019). In case of discrepancies in the assessment of bias between the two researchers, they will resolve it through discussion, and if necessary, the two researchers will discuss it together with a third researcher. 2.5 Data synthesis and statistical analysis In R4.3.1 software, the "meta" package is mainly used for meta-analysis operations. First, the data included in the study was imported into the R environment in a standardized format, including the basic information of the study, the AUC and its standard error and other key data. The meta-analysis was performed using the "metagen" function, which can set parameters for different data types and study designs. Heterogeneity was assessed using I² values and P values. When P<0.05, there was no significant heterogeneity among the studies. I²>75%, 25-75% and <25% represent high, medium and low heterogeneity levels, respectively. If P>0.1 and I²<50%, the heterogeneity of each study was acceptable, and the fixed-effect model was used for meta-analysis. On the contrary, if P≤0.1 and I²≥50%, it indicates that there is a large heterogeneity among the studies. Then, the random effects model is used for meta-analysis and sensitivity analysis is conducted to find the source of heterogeneity. Rigorous treatment strategies were employed to address potentially missing data from included studies. Firstly, the missing data is randomly processed by using the multiple interpolation method in the "mouse" package. The input data set of missing values is generated by several simulations, and the missing values are estimated by combining the known data information. For the non-random missing data whose mechanism is difficult to determine, the relevant data are carefully excluded without affecting the reliability of the research conclusions, and the possible impact of this processing method is explained in the research results and discussion. 3Results 3.1 Literature selection process and results A total of 3 056 relevant literatures were obtained, and 13 literatures (Sharathkumar et al., 2012; Kerlin et al., 2015; Connelly et al., 2016; Marquez and Shabanova et al., 2016; Spavor et al., 2016; Yen et al., 2016; Cairo et al., 2018; Kerris et al., 2020; Jaffray et al., 2021; Walker et al., 2021; Jaffray et al., 2022; Papillon et al., 2023; Tiratrakoonseree et al., 2024) were finally included after screening and re-screening. The literature screening process and results are shown in Figure 2. 3.2 Research characteristics Table 1 summarizes the basic characteristics of the 13 included studies. These studies were published between 2012 and 2024, primarily conducted in the United States, with only two conducted in other countries, namely Canada and Thailand. Among the included studies, there were 11 retrospective cohort studies and 2 prospective cohort studies. The earliest VTE study was conducted by Sharathkumar in 2012, with the most publications in
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