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A Guide to Estimating the Reference Range From a Meta-Analysis Using Aggregate or Individual Participant Data.

Abstract

Clinicians frequently must decide whether a patient's measurement reflects that of a healthy "normal" individual. Thus, the reference range is defined as the interval in which some proportion (frequently 95%) of measurements from a healthy population is expected to fall. One can estimate it from a single study or preferably from a meta-analysis of multiple studies to increase generalizability. This range differs from the confidence interval for the pooled mean and the prediction interval for a new study mean in a meta-analysis, which do not capture natural variation across healthy individuals. Methods for estimating the reference range from a meta-analysis of aggregate data that incorporates both within- and between-study variations were recently proposed. In this guide, we present 3 approaches for estimating the reference range: one frequentist, one Bayesian, and one empirical. Each method can be applied to either aggregate or individual-participant data meta-analysis, with the latter being the gold standard when available. We illustrate the application of these approaches to data from a previously published individual-participant data meta-analysis of studies measuring liver stiffness by transient elastography in healthy individuals between 2006 and 2016.

Citation

(2022). A Guide to Estimating the Reference Range From a Meta-Analysis Using Aggregate or Individual Participant Data. American Journal of Epidemiology, 948 - 956. https://doi.org/10.1093/aje/kwac013

Acceptance Date Jan 21, 2022
Publication Date May 1, 2022
Journal American Journal of Epidemiology
Print ISSN 0002-9262
Publisher Oxford University Press
Pages 948 - 956
DOI https://doi.org/10.1093/aje/kwac013
Publisher URL https://academic.oup.com/aje/article-abstract/191/5/948/6518210?redirectedFrom=fulltext

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