Ten Pearls and Pitfalls of Propensity Scores in Critical Care Research: A Guide for Clinicians and Researchers

Daniel E. Leisman

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Propensity scores are potentially useful tools in observational research. They are distinct from traditional covariate adjustment in that they attempt to disentangle confounders from exposure allocation rather than from outcome effects. Although they can provide value by reducing overfitting risk and loaning nuance to statistical modeling in select situations, propensity scores are generally not any more reliable than traditional adjustment. Further, propensity scores, and particularly PSM, obligate additional considerations that are less important for traditional covariate adjustments. Clinicians and researchers who read or perform propensity score studies should remember, propensity cannot account for unobserved bias or endogeneity, always involve lost information, are susceptible to missing data, and always involve trade-offs between internal and external validity. These issues are particularly relevant to critical care clinical research, and practitioners should appreciate these considerations when interpreting evidence derived from propensity scores.

Original languageEnglish
Pages (from-to)176-185
Number of pages10
JournalCritical Care Medicine
Volume47
Issue number2
DOIs
StatePublished - 2019

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