Predicting Functional Outcome Using 24‐Hour Post‐Treatment Characteristics: Application of Machine Learning Algorithms in the STRATIS Registry

• Published in: Annals of neurology 2023-01, Vol.93 (1), p.40-49
• Main Authors: Castonguay, Alicia C., Zoghi, Zeinab, Zaidat, Osama O., Burgess, Richard E., Zaidi, Syed F., Mueller‐Kronast, Nils, Liebeskind, David S., Jumaa, Mouhammad A.
• Format: Article
• Language: English
• Subjects: Accuracy; Algorithms; Continuity (mathematics); Decision trees; Humans; Ischemia; Ischemic Stroke - diagnosis; Learning algorithms; Machine Learning; Model accuracy; Performance prediction; Registries; Regression analysis; Stroke; Stroke - diagnosis; Stroke - therapy; Support vector machines
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.26528

Summary for Social Media @AliciaCastongu2, @FazalZaidi9, @oozaidat, @Mouhammad_Jumaa Objective Machine learning (ML) algorithms have emerged as powerful predictive tools in the field stroke. Here, we examine the predictive accuracy of ML models for predicting functional outcomes using 24‐hour post‐treatment characteristics in the Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke (STRATIS) Registry. Methods ML models, adaptive boost, random forest (RF), classification and regression trees (CART), C5.0 decision tree (C5.0), support vector machine (SVM), least absolute shrinkage and selection operator (LASSO), and logistic regression (LR), and traditional LR models were used to predict 90‐day functional outcome (modified Rankin Scale score 0–2). Twenty‐four‐hour National Institutes of Health Stroke Scale (NIHSS) was examined as a continuous or dichotomous variable in all models. Model accuracy was assessed using the area under characteristic curve (AUC). Results The 24‐hour NIHSS score was a top‐predictor of functional outcome in all models. ML models using the continuous 24‐hour NIHSS scored showed moderate‐to‐good predictive performance (range mean AUC: 0.76–0.92); however, RF (AUC: 0.92 ± 0.028) outperformed all ML models, except LASSO (AUC: 0.89 ± 0.023, p = 0.0958). Importantly, RF demonstrated a significantly higher predictive value than LR (AUC: 0.87 ± 0.031, p = 0.048) and traditional LR (AUC: 85 ± 0.06, p = 0.035) when using the 24‐hour continuous NIHSS score. Predictive accuracy was similar between the 24‐hour NIHSS score dichotomous and continuous ML models. Interpretation In this substudy, we found similar predictive accuracy for functional outcome when using the 24‐hour NIHSS score as a continuous or dichotomous variable in ML models. ML models had moderate‐to‐good predictive accuracy, with RF outperforming LR models. External validation of these ML models is warranted. ANN NEUROL 2023;93:40–49