# Machine learning-based COVID-19 prognostic models lag behind in reporting quality: findings from a TRIPOD/TRIPOD + AI systematic review

## TL;DR

This study finds that machine learning-based models for predicting outcomes in COVID-19 patients are poorly reported compared to traditional models, highlighting a need for better adherence to reporting standards.

## Contribution

The study introduces a systematic comparison of reporting quality between conventional and machine learning-based prognostic models for COVID-19 using TRIPOD and TRIPOD+AI guidelines.

## Key findings

- Machine learning-based studies showed significantly lower adherence to TRIPOD+AI guidelines compared to conventional models.
- No study fully adhered to abstract reporting requirements, and appropriate titles were rare.
- Both model types had major gaps in model description and performance reporting.

## Abstract

Reporting of COVID-19 prognostic models frequently falls short of established standards. The TRIPOD checklist and its 2024 AI extension (TRIPOD + AI) provide a comprehensive framework for assessing reporting quality. We therefore evaluated and compared reporting completeness in conventional versus machine-learning models.

Studies reporting the development, and internal and external validation of prognostic prediction models for COVID-19 using either conventional or machine learning-based algorithms were included. Literature searches were conducted in MEDLINE, Epistemonikos.org, and Scopus (up to July 31, 2024). Studies using conventional statistical methods were evaluated under TRIPOD, while machine learning-based studies were assessed using TRIPOD + AI. Data extraction followed TRIPOD and TRIPOD + AI checklists, measuring adherence per article and per checklist item. The protocol was prospectively registered at the Open Science Framework (https://osf.io/kg9yw).

A total of 53 studies describing 71 prognostic models were identified. Overall, adherence to both guidelines was low, with significantly poorer compliance among machine learning-based studies (TRIPOD + AI) compared to conventional model studies (TRIPOD) (28.4% vs. 38.1%, 95% CI of difference: 4.1–15.4). No study fully adhered to abstract reporting requirements, and appropriate titles were included in only a minority of cases (29.0%, 95% CI: 16.1–46.6 for TRIPOD; 13.6%, 95% CI: 4.8–33.3 for TRIPOD + AI). Sample size calculations were not fully reported in any study. Reporting of methods and results sections was poor across both frameworks.

Lower adherence among machine learning studies reflects the relatively recent publication of the TRIPOD + AI guidelines (April 2024), which postdate many of the included studies. Both conventional and machine learning-based prediction models showed insufficient reporting, with major gaps in model description and performance reporting. Greater compliance with reporting guidelines is critical to improving the clarity, reproducibility, and clinical value of prediction model research.

The online version contains supplementary material available at 10.1186/s41512-026-00218-x.