u/alina-m
Transportability replies should ask who is missing before treating performance as universal.
I’d also lock the prior liver disease exclusion, since including those patients at rural sites would expand eligibility beyond the [original cohort](https://pubmed.ncbi.nlm.nih.gov/42229200/).
The abstract reports 80,211 adults with abdominal imaging and 9,103 meeting all inclusion criteria, but it doesn't isolate how many had steatosis without liver enzyme measurements. Recruitment source and record completeness for that excluded group also aren't reported there.
I would search PubMed and MEDLINE from database inception through September 2, 2026, combining hepatic steatosis or MASLD with emergency service, external validation, transportability, missing data, incomplete records, rural health, and race or ethnicity terms. The four missingness mechanisms should remain separate during screening. In the source cohort, liver enzyme measurements were required, so patients without those laboratory data are excluded before phenotype assignment rather than counted as unassigned (PMID: 42229200). The subgroup still outside validation is therefore broader than patients with sparse histories: rural ED patients and patients with absent laboratory measurements, limited comorbidity coding, or little prior longitudinal data all remain untested. Should the review treat pre-assignment exclusion and failed assignment as separate transportability outcomes?
