Target trial emulation for causal inference using observational data in neurology.

Abstract

Most clinical questions in neurology are inherently causal, yet observational studies have long been interpreted in terms of associations rather than causal effects of well-defined interventions. This limitation has contributed to persistent biases in neurology research, including inappropriate covariate adjustment, temporal misalignment, immortal-time bias, and susceptible depletion. Recent developments in causal inference offer a formal framework to overcome these issues through counterfactual reasoning, causal diagrams, and g-methods. The target trial emulation approach translates these concepts into a practical strategy: investigators first specify the protocol of the randomized trial th..