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Zhu G, Ozkara BB, Chen H, Zhou B, Jiang B, Ding VY, Wintermark M. Enhancing hospital course and outcome prediction in patients with traumatic brain injury: A machine learning study. Neuroradiol J 2024; 37:74-83. [PMID: 37921691 PMCID: PMC10863571 DOI: 10.1177/19714009231212364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
PURPOSE We aimed to use machine learning (ML) algorithms with clinical, lab, and imaging data as input to predict various outcomes in traumatic brain injury (TBI) patients. METHODS In this retrospective study, blood samples were analyzed for glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1). The non-contrast head CTs were reviewed by two neuroradiologists for TBI common data elements (CDE). Three outcomes were designed to predict: discharged or admitted for further management (prediction 1), deceased or not deceased (prediction 2), and admission only, prolonged stay, or neurosurgery performed (prediction 3). Five ML models were trained. SHapley Additive exPlanations (SHAP) analyses were used to assess the relative significance of variables. RESULTS Four hundred forty patients were used to predict predictions 1 and 2, while 271 patients were used in prediction 3. Due to Prediction 3's hospitalization requirement, deceased and discharged patients could not be utilized. The Random Forest model achieved an average accuracy of 1.00 for prediction 1 and an accuracy of 0.99 for prediction 2. The Random Forest model achieved a mean accuracy of 0.93 for prediction 3. Key features were extracranial injury, hemorrhage, UCH-L1 for prediction 1; The Glasgow Coma Scale, age, GFAP for prediction 2; and GFAP, subdural hemorrhage volume, and pneumocephalus for prediction 3, per SHAP analysis. CONCLUSION Combining clinical and laboratory parameters with non-contrast CT CDEs allowed our ML models to accurately predict the designed outcomes of TBI patients. GFAP and UCH-L1 were among the significant predictor variables, demonstrating the importance of these biomarkers.
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Affiliation(s)
- Guangming Zhu
- Department of Neurology, The University of Arizona, USA
| | - Burak B Ozkara
- Department of Neuroradiology, MD Anderson Cancer Center, USA
| | - Hui Chen
- Department of Neuroradiology, MD Anderson Cancer Center, USA
| | - Bo Zhou
- Neuroradiology Division, Department of Radiology, Stanford University, USA
| | - Bin Jiang
- Neuroradiology Division, Department of Radiology, Stanford University, USA
| | - Victoria Y Ding
- Quantitative Sciences Unit, Department of Medicine, Stanford University, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson Cancer Center, USA
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Levy AS, Bhatia S, Merenzon MA, Andryski AL, Rivera CA, Daggubati LC, Di L, Shah AH, Komotar RJ, Ivan ME. Exploring the Landscape of Machine Learning Applications in Neurosurgery: A Bibliometric Analysis and Narrative Review of Trends and Future Directions. World Neurosurg 2024; 181:108-115. [PMID: 37839564 DOI: 10.1016/j.wneu.2023.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The field of neurosurgery has consistently represented an area of innovation and integration of technology since its inception. As such, machine learning (ML) has found its way into applications within neurosurgery relatively rapidly. Through this bibliometric review and cluster analysis, we seek to identify trends and emerging applications of ML within neurosurgery. METHODS A bibliometric analysis was carried out in the Web of Science database on publications from January 2000 to March 2023. The full data set of the 200 most cited publications including title, author information, journal, citation count, keywords, and abstracts for each publication was evaluated in CiteSpace. CiteSpace was used to elucidate publication characteristics, trends, and topic clusters via collaborate network analysis using the Kamada-Kawai algorithm. RESULTS The 25 most cited titles were included in our analysis. Harvard University and its affiliates represented the top institution, contributing nearly 25% of publications in the literature. WORLD NEUROSURGERY was the journal with the highest net citation count of 747 (29%). Collaborative network analysis generated 12 unique clusters, the largest of which was machine learning, followed by feature importance and deep brain stimulation. CONCLUSION This review highlights the most impactful articles pertaining to ML in the field of neurosurgery. ML has been applied into several sub-specialties within neurosurgery to optimize patient care, with special attention to outcome predictors, patient selection, and surgical decision making.
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Affiliation(s)
- Adam S Levy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
| | - Shovan Bhatia
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Martin A Merenzon
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Allie L Andryski
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Cameron A Rivera
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Lekhaj C Daggubati
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Long Di
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
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Wu Z, Lai J, Huang Q, Lin L, Lin S, Chen X, Huang Y. Machine learning-based model for predicting inpatient mortality in adults with traumatic brain injury: a systematic review and meta-analysis. Front Neurosci 2023; 17:1285904. [PMID: 38156272 PMCID: PMC10753007 DOI: 10.3389/fnins.2023.1285904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 12/30/2023] Open
Abstract
Background and objective Predicting mortality from traumatic brain injury facilitates early data-driven treatment decisions. Machine learning has predicted mortality from traumatic brain injury in a growing number of studies, and the aim of this study was to conduct a meta-analysis of machine learning models in predicting mortality from traumatic brain injury. Methods This systematic review and meta-analysis included searches of PubMed, Web of Science and Embase from inception to June 2023, supplemented by manual searches of study references and review articles. Data were analyzed using Stata 16.0 software. This study is registered with PROSPERO (CRD2023440875). Results A total of 14 studies were included. The studies showed significant differences in the overall sample, model type and model validation. Predictive models performed well with a pooled AUC of 0.90 (95% CI: 0.87 to 0.92). Conclusion Overall, this study highlights the excellent predictive capabilities of machine learning models in determining mortality following traumatic brain injury. However, it is important to note that the optimal machine learning modeling approach has not yet been identified. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=440875, identifier CRD2023440875.
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Affiliation(s)
- Zhe Wu
- Department of Neuronal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jinqing Lai
- Department of Neuronal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Qiaomei Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Long Lin
- Department of Neurosurgery, Fuzong Clinical Medical College, Fuzhou, Fujian, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xiangrong Chen
- Department of Neuronal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yinqiong Huang
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Matsuo K, Aihara H, Hara Y, Morishita A, Sakagami Y, Miyake S, Tatsumi S, Ishihara S, Tohma Y, Yamashita H, Sasayama T. Machine Learning to Predict Three Types of Outcomes After Traumatic Brain Injury Using Data at Admission: A Multi-Center Study for Development and Validation. J Neurotrauma 2023; 40:1694-1706. [PMID: 37029810 DOI: 10.1089/neu.2022.0515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
The difficulty of accurately identifying patients who would benefit from promising treatments makes it challenging to prove the efficacy of novel treatments for traumatic brain injury (TBI). Although machine learning is being increasingly applied to this task, existing binary outcome prediction models are insufficient for the effective stratification of TBI patients. The aim of this study was to develop an accurate 3-class outcome prediction model to enable appropriate patient stratification. To this end, retrospective balanced data of 1200 blunt TBI patients admitted to six Japanese hospitals from January 2018 onwards (200 consecutive cases at each institution) were used for model training and validation. We incorporated 21 predictors obtained in the emergency department, including age, sex, six clinical findings, four laboratory parameters, eight computed tomography findings, and an emergency craniotomy. We developed two machine learning models (XGBoost and dense neural network) and logistic regression models to predict 3-class outcomes based on the Glasgow Outcome Scale-Extended (GOSE) at discharge. The prediction models were developed using a training dataset with n = 1000, and their prediction performances were evaluated over two validation rounds on a validation dataset (n = 80) and a test dataset (n = 120) using the bootstrap method. Of the 1200 patients in aggregate, the median patient age was 71 years, 199 (16.7%) exhibited severe TBI, and emergency craniotomy was performed on 104 patients (8.7%). The median length of stay was 13.0 days. The 3-class outcomes were good recovery/moderate disability for 709 patients (59.1%), severe disability/vegetative state in 416 patients (34.7%), and death in 75 patients (6.2%). XGBoost model performed well with 69.5% sensitivity, 82.5% accuracy, and an area under the receiver operating characteristic curve of 0.901 in the final validation. In terms of the receiver operating characteristic curve analysis, the XGBoost outperformed the neural network-based and logistic regression models slightly. In particular, XGBoost outperformed the logistic regression model significantly in predicting severe disability/vegetative state. Although each model predicted favorable outcomes accurately, they tended to miss the mortality prediction. The proposed machine learning model was demonstrated to be capable of accurate prediction of in-hospital outcomes following TBI, even with the three GOSE-based categories. As a result, it is expected to be more impactful in the development of appropriate patient stratification methods in future TBI studies than conventional binary prognostic models. Further, outcomes were predicted based on only clinical data obtained from the emergency department. However, developing a robust model with consistent performance in diverse scenarios remains challenging, and further efforts are needed to improve generalization performance.
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Affiliation(s)
- Kazuya Matsuo
- Department of Neurosurgery, Hyogo Emergency Medical Center and Kobe Red Cross Hospital, Kobe, Japan
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideo Aihara
- Department of Neurosurgery, Hyogo Prefectural Himeji Cardiovascular Center, Himeji, Japan
| | - Yoshie Hara
- Department of Neurosurgery, Hyogo Emergency Medical Center and Kobe Red Cross Hospital, Kobe, Japan
| | - Akitsugu Morishita
- Department of Neurosurgery, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan
| | - Yoshio Sakagami
- Department of Neurosurgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Shigeru Miyake
- Department of Neurosurgery, Kita-harima Medical Center, Ono, Japan
| | - Shotaro Tatsumi
- Department of Neurosurgery, Hirohata Steel Memorial Hospital, Himeji, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Yoshiki Tohma
- Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan
| | - Haruo Yamashita
- Department of Neurosurgery, Hyogo Emergency Medical Center and Kobe Red Cross Hospital, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Say I, Chen YE, Sun MZ, Li JJ, Lu DC. Machine learning predicts improvement of functional outcomes in traumatic brain injury patients after inpatient rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005168. [PMID: 36211830 PMCID: PMC9535093 DOI: 10.3389/fresc.2022.1005168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Survivors of traumatic brain injury (TBI) have an unpredictable clinical course. This unpredictability makes clinical resource allocation for clinicians and anticipatory guidance for patients difficult. Historically, experienced clinicians and traditional statistical models have insufficiently considered all available clinical information to predict functional outcomes for a TBI patient. Here, we harness artificial intelligence and apply machine learning and statistical models to predict the Functional Independence Measure (FIM) scores after rehabilitation for traumatic brain injury (TBI) patients. Tree-based algorithmic analysis of 629 TBI patients admitted to a large acute rehabilitation facility showed statistically significant improvement in motor and cognitive FIM scores at discharge.
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Affiliation(s)
- Irene Say
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Yiling Elaine Chen
- Department of Statistics, University of California, Los Angeles, CA, United States
| | - Matthew Z. Sun
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Jingyi Jessica Li
- Department of Statistics, University of California, Los Angeles, CA, United States
| | - Daniel C. Lu
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Brain Research Institute, University of California, Los Angeles, CA, United States
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