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Otieno JA, Häggström J, Darehed D, Eriksson M. Developing machine learning models to predict multi-class functional outcomes and death three months after stroke in Sweden. PLoS One 2024; 19:e0303287. [PMID: 38739586 PMCID: PMC11090298 DOI: 10.1371/journal.pone.0303287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Globally, stroke is the third-leading cause of mortality and disability combined, and one of the costliest diseases in society. More accurate predictions of stroke outcomes can guide healthcare organizations in allocating appropriate resources to improve care and reduce both the economic and social burden of the disease. We aim to develop and evaluate the performance and explainability of three supervised machine learning models and the traditional multinomial logistic regression (mLR) in predicting functional dependence and death three months after stroke, using routinely-collected data. This prognostic study included adult patients, registered in the Swedish Stroke Registry (Riksstroke) from 2015 to 2020. Riksstroke contains information on stroke care and outcomes among patients treated in hospitals in Sweden. Prognostic factors (features) included demographic characteristics, pre-stroke functional status, cardiovascular risk factors, medications, acute care, stroke type, and severity. The outcome was measured using the modified Rankin Scale at three months after stroke (a scale of 0-2 indicates independent, 3-5 dependent, and 6 dead). Outcome prediction models included support vector machines, artificial neural networks (ANN), eXtreme Gradient Boosting (XGBoost), and mLR. The models were trained and evaluated on 75% and 25% of the dataset, respectively. Model predictions were explained using SHAP values. The study included 102,135 patients (85.8% ischemic stroke, 53.3% male, mean age 75.8 years, and median NIHSS of 3). All models demonstrated similar overall accuracy (69%-70%). The ANN and XGBoost models performed significantly better than the mLR in classifying dependence with F1-scores of 0.603 (95% CI; 0.594-0.611) and 0.577 (95% CI; 0.568-0.586), versus 0.544 (95% CI; 0.545-0.563) for the mLR model. The factors that contributed most to the predictions were expectedly similar in the models, based on clinical knowledge. Our ANN and XGBoost models showed a modest improvement in prediction performance and explainability compared to mLR using routinely-collected data. Their improved ability to predict functional dependence may be of particular importance for the planning and organization of acute stroke care and rehabilitation.
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Affiliation(s)
| | - Jenny Häggström
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - David Darehed
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Marie Eriksson
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
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Altersberger VL, Wright PR, Schaedelin SA, De Marchis GM, Gensicke H, Engelter ST, Psychogios M, Kahles T, Goeldlin M, Meinel TR, Mordasini P, Kaesmacher J, von Hessling A, Vehoff J, Weber J, Wegener S, Salmen S, Sturzenegger R, Medlin F, Berger C, Schelosky L, Renaud S, Niederhauser J, Bonvin C, Schaerer M, Mono ML, Rodic B, Schwegler G, Peters N, Bolognese M, Luft AR, Cereda CW, Kägi G, Michel P, Carrera E, Arnold M, Fischer U, Nedeltchev K, Bonati LH. Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers—An analysis of the Swiss Stroke Registry. Eur Stroke J 2022; 7:117-125. [DOI: 10.1177/23969873221094408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction: Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time. Patients and methods: We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday–Friday 8:00–17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months. Results: Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59–116) vs 95 (66–130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04–1.18]) and increased mortality (1.13 [95%CI: 1.01–1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased. Discussion and Conclusion: Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine A Schaedelin
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | | | - Jochen Vehoff
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephan Salmen
- Department of Neurology, Spitalzentrum Biel, Biel, Switzerland
| | | | - Friedrich Medlin
- Department of Internal Medicine, Stroke Unit and Division of Neurology, HFR Fribourg, Cantonal Hospital, Fribourg, Switzerland
| | | | | | - Susanne Renaud
- Stroke Unit and Division of Neurology, Neuchatel Hospital Network, Neuchatel, Switzerland
| | | | | | | | | | - Biljana Rodic
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Nils Peters
- Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland
| | | | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Weggis, Switzerland
| | - Carlo W Cereda
- Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
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Shokri HM, El Nahas NM, Aref HM, Dawood NL, Abushady EM, Abd Eldayem EH, Georgy SS, Zaki AS, Bedros RY, Wahid El Din MM, Roushdy TM. Factors related to time of stroke onset versus time of hospital arrival: A SITS registry-based study in an Egyptian stroke center. PLoS One 2020; 15:e0238305. [PMID: 32915811 PMCID: PMC7485782 DOI: 10.1371/journal.pone.0238305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/13/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND High-quality data on time of stroke onset and time of hospital arrival is required for proper evaluation of points of delay that might hinder access to medical care after the onset of stroke symptoms. PURPOSE Based on (SITS Dataset) in Egyptian stroke patients, we aimed to explore factors related to time of onset versus time of hospital arrival for acute ischemic stroke (AIS). MATERIAL AND METHODS We included 1,450 AIS patients from two stroke centers of Ain Shams University, Cairo, Egypt. We divided the day to four quarters and evaluated relationship between different factors and time of stroke onset and time of hospital arrival. The factors included: age, sex, duration from stroke onset to hospital arrival, type of management, type of stroke (TOAST classification), National Institute of Health Stroke Scale (NIHSS) on admission and favorable outcome modified Rankin Scale (mRS ≤2). RESULTS Pre-hospital: highest stroke incidence was in the first and fourth quarters. There was no significant difference in the mean age, sex, type of stroke in relation to time of onset. NIHSS was significantly less in onset in third quarter of the day. Percentage of patients who received thrombolytic therapy was higher with onset in the first 2 quarters of the day (p = <0.001). In-hospital: there was no difference in percentage of patients who received thrombolytic therapy nor in outcome across 4 quarters of arrival to hospital. CONCLUSION Pre-hospital factors still need adjustment to improve percentage of thrombolysis, while in-hospital factors showed consistent performance.
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Affiliation(s)
- Hossam M. Shokri
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- * E-mail:
| | - Nevine M. El Nahas
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany M. Aref
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Noha L. Dawood
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman M. Abushady
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman H. Abd Eldayem
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady S. Georgy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr S. Zaki
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rady Y. Bedros
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mona M. Wahid El Din
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer M. Roushdy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Rusek L, Persson CU, Svärdsudd K, Blomstrand A, Blomstrand C, Welin L, Caidahl K, Hansson P. Lifetime risk of stroke in the general male population. Acta Neurol Scand 2020; 142:30-36. [PMID: 32090315 DOI: 10.1111/ane.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/19/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Most previous studies of incidence rates of stroke are from register studies, while data from prospective cohort studies are limited. The aim of the present study was to describe hazard rates, prevalence and cumulative proportion free from stroke during a lifelong follow-up of a representative sample of middle-aged men sampled from the general population. METHODS A population-based sample of 855 men, all born in 1913, was investigated at 50 years of age and followed up with repeated medical examinations at age 54, 60, 67, 75 and 80. Data from hospital records and the Cause of Death Register were collected, and all stroke events during 48 years of follow-up were registered. Medical records were scrutinized in order to confirm and validate the stroke diagnoses. RESULTS One man was excluded because of stroke prior to baseline, while 176 of the remaining 854 men (20.7%) suffered a first-ever stroke during follow-up. The total 5-year stroke risk (hazard rate) increased with age, from 3.54 (95% CI: 0-7.55) per 1000 persons at risk at age 50 years, to 119.05 (95% CI: 45.39-192.70) at age 90 years. The stroke prevalence peaked at age 80 and older, with about 120 cases per 1000 years of observation. The survival rate (cumulative proportion free from stroke) at age 98 was 50.0%. CONCLUSION One out of five men in this population sample suffered a stroke of any type during follow-up from 50 to 98 years of age and the cumulative incidence was close to 50%.
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Affiliation(s)
- Linnéa Rusek
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Carina U. Persson
- Department of Clinical Neuroscience, Rehabilitation Medicine Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Kurt Svärdsudd
- Department of Public Health and Caring Sciences Family Medicine and Preventive Medicine Section Uppsala University Uppsala Sweden
| | - Ann Blomstrand
- Primary Health Care School of Public Health and Community Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience Stroke Centre West Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Lennart Welin
- Department of Medicine Lidköping Hospital Lidköping Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Per‐Olof Hansson
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
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