1
|
Cai YQ, Gong DX, Tang LY, Cai Y, Li HJ, Jing TC, Gong M, Hu W, Zhang ZW, Zhang X, Zhang GW. Pitfalls in Developing Machine Learning Models for Predicting Cardiovascular Diseases: Challenge and Solutions. J Med Internet Res 2024; 26:e47645. [PMID: 38869157 DOI: 10.2196/47645] [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] [Received: 03/29/2023] [Revised: 10/30/2023] [Accepted: 06/12/2024] [Indexed: 06/14/2024] Open
Abstract
In recent years, there has been explosive development in artificial intelligence (AI), which has been widely applied in the health care field. As a typical AI technology, machine learning models have emerged with great potential in predicting cardiovascular diseases by leveraging large amounts of medical data for training and optimization, which are expected to play a crucial role in reducing the incidence and mortality rates of cardiovascular diseases. Although the field has become a research hot spot, there are still many pitfalls that researchers need to pay close attention to. These pitfalls may affect the predictive performance, credibility, reliability, and reproducibility of the studied models, ultimately reducing the value of the research and affecting the prospects for clinical application. Therefore, identifying and avoiding these pitfalls is a crucial task before implementing the research. However, there is currently a lack of a comprehensive summary on this topic. This viewpoint aims to analyze the existing problems in terms of data quality, data set characteristics, model design, and statistical methods, as well as clinical implications, and provide possible solutions to these problems, such as gathering objective data, improving training, repeating measurements, increasing sample size, preventing overfitting using statistical methods, using specific AI algorithms to address targeted issues, standardizing outcomes and evaluation criteria, and enhancing fairness and replicability, with the goal of offering reference and assistance to researchers, algorithm developers, policy makers, and clinical practitioners.
Collapse
Affiliation(s)
- Yu-Qing Cai
- The First Hospital of China Medical University, Shenyang, China
| | - Da-Xin Gong
- Smart Hospital Management Department, The First Hospital of China Medical University, Shenyang, China
| | - Li-Ying Tang
- The First Hospital of China Medical University, Shenyang, China
| | - Yue Cai
- The First Hospital of China Medical University, Shenyang, China
| | - Hui-Jun Li
- Shenyang Medical & Film Science and Technology Co, Ltd, Shenyang, China
| | - Tian-Ci Jing
- Smart Hospital Management Department, The First Hospital of China Medical University, Shenyang, China
| | | | - Wei Hu
- Bayi Orthopedic Hospital, Chengdu, China
| | - Zhen-Wei Zhang
- China Rongtong Medical & Healthcare Co, Ltd, Chengdu, China
| | - Xingang Zhang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Guang-Wei Zhang
- Smart Hospital Management Department, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
2
|
Zhu FY, Sun YF, Yin XP, Zhang Y, Xing LH, Ma ZP, Xue LY, Wang JN. Using machine learning-based radiomics to differentiate between glioma and solitary brain metastasis from lung cancer and its subtypes. Discov Oncol 2023; 14:224. [PMID: 38055122 DOI: 10.1007/s12672-023-00837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To establish a machine learning-based radiomics model to differentiate between glioma and solitary brain metastasis from lung cancer and its subtypes, thereby achieving accurate preoperative classification. MATERIALS AND METHODS A retrospective analysis was conducted on MRI T1WI-enhanced images of 105 patients with glioma and 172 patients with solitary brain metastasis from lung cancer, which were confirmed pathologically. The patients were divided into the training group and validation group in an 8:2 ratio for image segmentation, extraction, and filtering; multiple layer perceptron (MLP), support vector machine (SVM), random forest (RF), and logistic regression (LR) were used for modeling; fivefold cross-validation was used to train the model; the validation group was used to evaluate and assess the predictive performance of the model, ROC curve was used to calculate the accuracy, sensitivity, and specificity of the model, and the area under curve (AUC) was used to assess the predictive performance of the model. RESULTS The accuracy and AUC of the MLP differentiation model for high-grade glioma and solitary brain metastasis in the validation group was 0.992, 1.000, respectively, while the sensitivity and specificity were 1.000, 0.968, respectively. The accuracy and AUC for the MLP and SVM differentiation model for high-grade glioma and small cell lung cancer brain metastasis in the validation group was 0.966, 1.000, respectively, while the sensitivity and specificity were 1.000, 0.929, respectively. The accuracy and AUC for the MLP differentiation model for high-grade glioma and non-small cell lung cancer brain metastasis in the validation group was 0.982, 0.999, respectively, while the sensitivity and specificity were 0.958, 1.000, respectively. CONCLUSION The application of machine learning-based radiomics has a certain clinical value in differentiating glioma from solitary brain metastasis from lung cancer and its subtypes. In the HGG/SBM and HGG/NSCLC SBM validation groups, the MLP model had the best diagnostic performance, while in the HGG/SCLC SBM validation group, the MLP and SVM models had the best diagnostic performance.
Collapse
Affiliation(s)
- Feng-Ying Zhu
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Yu-Feng Sun
- College of Electronic Information Engineering, Hebei University, Baoding, 071002, China
| | - Xiao-Ping Yin
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Yu Zhang
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Li-Hong Xing
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Ze-Peng Ma
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China
| | - Lin-Yan Xue
- College of Quality and Technical Supervision, Hebei University, No.180 of Wusi Road, Lianchi District, Baoding, 071002, China.
| | - Jia-Ning Wang
- Department of Radiology, Affiliated Hospital of Hebei University, No.212 of Yuhua Road, Lianchi District, Baoding, 071000, China.
| |
Collapse
|
3
|
Gupta NS, Kumar P. Perspective of artificial intelligence in healthcare data management: A journey towards precision medicine. Comput Biol Med 2023; 162:107051. [PMID: 37271113 DOI: 10.1016/j.compbiomed.2023.107051] [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] [Received: 04/11/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
Mounting evidence has highlighted the implementation of big data handling and management in the healthcare industry to improve the clinical services. Various private and public companies have generated, stored, and analyzed different types of big healthcare data, such as omics data, clinical data, electronic health records, personal health records, and sensing data with the aim to move in the direction of precision medicine. Additionally, with the advancement in technologies, researchers are curious to extract the potential involvement of artificial intelligence and machine learning on big healthcare data to enhance the quality of patient's lives. However, seeking solutions from big healthcare data requires proper management, storage, and analysis, which imposes hinderances associated with big data handling. Herein, we briefly discuss the implication of big data handling and the role of artificial intelligence in precision medicine. Further, we also highlighted the potential of artificial intelligence in integrating and analyzing the big data that offer personalized treatment. In addition, we briefly discuss the applications of artificial intelligence in personalized treatment, especially in neurological diseases. Lastly, we discuss the challenges and limitations imposed by artificial intelligence in big data management and analysis to hinder precision medicine.
Collapse
Affiliation(s)
- Nancy Sanjay Gupta
- Molecular Neuroscience and Functional Genomics Laboratory, Department of Biotechnology, Delhi Technological University, India
| | - Pravir Kumar
- Molecular Neuroscience and Functional Genomics Laboratory, Department of Biotechnology, Delhi Technological University, India.
| |
Collapse
|
4
|
Jeon ET, Lee HJ, Park TY, Jin KN, Ryu B, Lee HW, Kim DH. Machine learning-based prediction of in-ICU mortality in pneumonia patients. Sci Rep 2023; 13:11527. [PMID: 37460837 DOI: 10.1038/s41598-023-38765-8] [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: 03/06/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023] Open
Abstract
Conventional severity-of-illness scoring systems have shown suboptimal performance for predicting in-intensive care unit (ICU) mortality in patients with severe pneumonia. This study aimed to develop and validate machine learning (ML) models for mortality prediction in patients with severe pneumonia. This retrospective study evaluated patients admitted to the ICU for severe pneumonia between January 2016 and December 2021. The predictive performance was analyzed by comparing the area under the receiver operating characteristic curve (AU-ROC) of ML models to that of conventional severity-of-illness scoring systems. Three ML models were evaluated: (1) logistic regression with L2 regularization, (2) gradient-boosted decision tree (LightGBM), and (3) multilayer perceptron (MLP). Among the 816 pneumonia patients included, 223 (27.3%) patients died. All ML models significantly outperformed the Simplified Acute Physiology Score II (AU-ROC: 0.650 [0.584-0.716] vs 0.820 [0.771-0.869] for logistic regression vs 0.827 [0.777-0.876] for LightGBM 0.838 [0.791-0.884] for MLP; P < 0.001). In the analysis for NRI, the LightGBM and MLP models showed superior reclassification compared with the logistic regression model in predicting in-ICU mortality in all length of stay in the ICU subgroups; all age subgroups; all subgroups with any APACHE II score, PaO2/FiO2 ratio < 200; all subgroups with or without history of respiratory disease; with or without history of CVA or dementia; treatment with mechanical ventilation, and use of inotropic agents. In conclusion, the ML models have excellent performance in predicting in-ICU mortality in patients with severe pneumonia. Moreover, this study highlights the potential advantages of selecting individual ML models for predicting in-ICU mortality in different subgroups.
Collapse
Affiliation(s)
- Eun-Tae Jeon
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, South Korea
| | - Hyo Jin Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, South Korea
| | - Tae Yun Park
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, South Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, South Korea
| | - Borim Ryu
- Center for Data Science, Biomedical Research Institute, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyun Woo Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, South Korea.
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-gu, Seoul, South Korea.
| |
Collapse
|
5
|
Chen M, Zhou L, Fan L, Li Y, Wang H. Prognostic prediction of thrombolytic therapy with rt-PA in acute ischemic stroke patients using an artificial intelligence model. Am J Transl Res 2023; 15:4735-4745. [PMID: 37560207 PMCID: PMC10408517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/07/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Through the comparison of different prediction models, we hope to find a promising statistical method to evaluate the prognosis of patients with acute ischemic stroke (AIS) after thrombolytic therapy. METHODS Data of 518 patients who received thrombolytic therapy were retrospectively collected in this study. Among them, 362 patients met the eligibility criteria, so their data such as age, sex, smoking history, previous medical history, clinical and laboratory indicators were analyzed. According to the 3 month follow-up results, 266 patients were included in a good prognosis group (modified Rankin Scale (mRS) score ≤2) and 96 in a poor prognosis group (3≤mRS≤6). All variables with P<0.05 in univariant and multivariant analyses were assigned in logistic regression model and artificial neural network (ANN) model to predict neurological prognosis, and the performance of the two models were compared. RESULTS Age, NIHSS scores, the serum concentration of immediate glucose, APTT and MBP at admission were found to be the predictive factors through ANN and logistic regression analysis. The binary logistic regression model revealed that the percentage correction, the precision, recall and F1 score of the regression model were 79%, 69.23%, 37.50% and 48.65%, respectively. While those of ANN were 79.98%, 69.70%, 37.25%, and 49.66%, correspondingly. CONCLUSIONS ANN model is as effective as a logistic regression model in predicting the prognosis of AIS after thrombolytic therapy with rt-PA. Moreover, ANN is slightly superior to logistic regression in accuracy, precision and F1 score.
Collapse
Affiliation(s)
- Miao Chen
- Department of Emergency, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570102, Hainan, China
- Department of Emergency, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of MedicineShanghai 200092, China
| | - Liya Zhou
- Information Management and Engineering, Shanghai University of Finance and EconomicsShanghai 200433, China
| | - Limin Fan
- The Institute for Biomedical Engineering and Nano Science, Tongji University School of MedicineShanghai 200092, China
| | - Yanhong Li
- Information Management and Engineering, Shanghai University of Finance and EconomicsShanghai 200433, China
| | - Hairong Wang
- Department of Emergency, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of MedicineShanghai 200092, China
| |
Collapse
|
6
|
Miceli G, Basso MG, Rizzo G, Pintus C, Cocciola E, Pennacchio AR, Tuttolomondo A. Artificial Intelligence in Acute Ischemic Stroke Subtypes According to Toast Classification: A Comprehensive Narrative Review. Biomedicines 2023; 11:biomedicines11041138. [PMID: 37189756 DOI: 10.3390/biomedicines11041138] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The correct recognition of the etiology of ischemic stroke (IS) allows tempestive interventions in therapy with the aim of treating the cause and preventing a new cerebral ischemic event. Nevertheless, the identification of the cause is often challenging and is based on clinical features and data obtained by imaging techniques and other diagnostic exams. TOAST classification system describes the different etiologies of ischemic stroke and includes five subtypes: LAAS (large-artery atherosclerosis), CEI (cardio embolism), SVD (small vessel disease), ODE (stroke of other determined etiology), and UDE (stroke of undetermined etiology). AI models, providing computational methodologies for quantitative and objective evaluations, seem to increase the sensitivity of main IS causes, such as tomographic diagnosis of carotid stenosis, electrocardiographic recognition of atrial fibrillation, and identification of small vessel disease in magnetic resonance images. The aim of this review is to provide overall knowledge about the most effective AI models used in the differential diagnosis of ischemic stroke etiology according to the TOAST classification. According to our results, AI has proven to be a useful tool for identifying predictive factors capable of subtyping acute stroke patients in large heterogeneous populations and, in particular, clarifying the etiology of UDE IS especially detecting cardioembolic sources.
Collapse
Affiliation(s)
- Giuseppe Miceli
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Maria Grazia Basso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Giuliana Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Chiara Pintus
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Elena Cocciola
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Andrea Roberta Pennacchio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università Degli Studi di Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90141 Palermo, Italy
| |
Collapse
|
7
|
Chung CC, Su ECY, Chen JH, Chen YT, Kuo CY. XGBoost-Based Simple Three-Item Model Accurately Predicts Outcomes of Acute Ischemic Stroke. Diagnostics (Basel) 2023; 13:diagnostics13050842. [PMID: 36899986 PMCID: PMC10000880 DOI: 10.3390/diagnostics13050842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
An all-inclusive and accurate prediction of outcomes for patients with acute ischemic stroke (AIS) is crucial for clinical decision-making. This study developed extreme gradient boosting (XGBoost)-based models using three simple factors-age, fasting glucose, and National Institutes of Health Stroke Scale (NIHSS) scores-to predict the three-month functional outcomes after AIS. We retrieved the medical records of 1848 patients diagnosed with AIS and managed at a single medical center between 2016 and 2020. We developed and validated the predictions and ranked the importance of each variable. The XGBoost model achieved notable performance, with an area under the curve of 0.8595. As predicted by the model, the patients with initial NIHSS score > 5, aged over 64 years, and fasting blood glucose > 86 mg/dL were associated with unfavorable prognoses. For patients receiving endovascular therapy, fasting glucose was the most important predictor. The NIHSS score at admission was the most significant predictor for those who received other treatments. Our proposed XGBoost model showed a reliable predictive power of AIS outcomes using readily available and simple predictors and also demonstrated the validity of the model for application in patients receiving different AIS treatments, providing clinical evidence for future optimization of AIS treatment strategies.
Collapse
Affiliation(s)
- Chen-Chih Chung
- Department of Neurology, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City 110, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Jia-Hung Chen
- Department of Neurology, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Yi-Tui Chen
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei City 103, Taiwan
| | - Chao-Yang Kuo
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan
- Correspondence: ; Tel.: +886-2-28227101 (ext. 1385)
| |
Collapse
|
8
|
Chung CC, Bamodu OA, Hong CT, Chan L, Chiu HW. Application of machine learning-based models to boost the predictive power of the SPAN index. Int J Neurosci 2023; 133:26-36. [PMID: 33499706 DOI: 10.1080/00207454.2021.1881092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study re-explored the predictive validity of Stroke Prognostication using Age and National Institutes of Health Stroke Scale (SPAN) index in patients who received different treatments for acute ischemic stroke (AIS) and developed machine learning-boosted outcome prediction models. METHODS We evaluated the prognostic relevance of SPAN index in patients with AIS who received intravenous tissue-type plasminogen activator (IV-tPA), intra-arterial thrombolysis (IAT) or non-thrombolytic treatments (non-tPA), and applied machine learning algorithms to develop SPAN-based outcome prediction models in a cohort of 2145 hospitalized AIS patients. The performance of the models was assessed and compared using the area under the receiver operating characteristic curves (AUCs). RESULTS SPAN index ≥100 was associated with higher mortality rate and higher modified Rankin Scale at discharge in AIS patients who received the different treatments. Compared to the lower AUCs for the SPAN-alone model across all groups, the AUCs of the logistic regression-boosted model were 0.838, 0.857, 0.766 and 0.875 for the whole cohort, non-tPA, IV-tPA and IAT groups, respectively. Similarly, the AUCs of the generated artificial neural network were 0.846, 0.858, 0.785 and 0.859 for the whole cohort, non-tPA, IV-tPA and IAT groups, respectively, while for gradient boosting decision tree model, we computed 0.850, 0.863, 0.779 and 0.815. CONCLUSIONS SPAN index has prognostic relevance in patients with AIS who received different treatments. The generated machine learning-based models exhibit good performance for predicting the functional recovery of AIS; thus, their proposed clinical application to aid outcome prediction and decision-making for the patients with AIS.
Collapse
Affiliation(s)
- Chen-Chih Chung
- Department of Neurology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Oluwaseun Adebayo Bamodu
- Department of Hematology and Oncology, Cancer Center, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Urology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Medical Research & Education, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan.,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei City, Taiwan
| |
Collapse
|
9
|
Multilayer perceptron-based prediction of stroke mimics in prehospital triage. Sci Rep 2022; 12:17994. [PMID: 36289277 PMCID: PMC9606292 DOI: 10.1038/s41598-022-22919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
The identification of stroke mimics (SMs) in patients with stroke could lead to delayed diagnosis and waste of medical resources. Multilayer perceptron (MLP) was proved to be an accurate tool for clinical applications. However, MLP haven't been applied in patients with suspected stroke onset within 24 h. Here, we aimed to develop a MLP model to predict SM in patients. We retrospectively reviewed the data of patients with a prehospital diagnosis of suspected stroke between July 2017 and June 2021. SMs were confirmed during hospitalization. We included demographic information, clinical manifestations, medical history, and systolic and diastolic pressure on admission. First, the cohort was randomly divided into a training set (70%) and an external testing set (30%). Then, the least absolute shrinkage and selection operator (LASSO) method was used in feature selection and an MLP model was trained based on the selected items. Then, we evaluated the performance of the model using the ten-fold cross validation method. Finally, we used the external testing set to compare the MLP model with FABS scoring system (FABS) and TeleStroke Mimic Score (TM-Score) using a receiver operator characteristic (ROC) curve. In total, 402 patients were included. Of these, 82 (20.5%) were classified as SMs. During the ten-fold cross validation, the mean area under the ROC curve (AUC) of 10 training sets and 10 validation sets were 0.92 and 0.87, respectively. In the external testing set, the AUC of the MLP model was significantly higher than that of the FABS (0.855 vs. 0.715, P = 0.038) and TM-Score (0.855 vs. 0.646, P = 0.006). The MLP model had significantly better performance in predicting SMs than FABS and TM-Score.
Collapse
|
10
|
Milton AG, Lau S, Kremer KL, Rao SR, Mas E, Snel MF, Trim PJ, Sharma D, Edwards S, Jenkinson M, Kleinig T, Noschka E, Hamilton-Bruce MA, Koblar SA. FAST-IT: Find A Simple Test - In TIA (transient ischaemic attack): a prospective cohort study to develop a multivariable prediction model for diagnosis of TIA through proteomic discovery and candidate lipid mass spectrometry, neuroimaging and machine learning-study protocol. BMJ Open 2022; 12:e045908. [PMID: 35365506 PMCID: PMC8977752 DOI: 10.1136/bmjopen-2020-045908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Transient ischaemic attack (TIA) may be a warning sign of stroke and difficult to differentiate from minor stroke and TIA-mimics. Urgent evaluation and diagnosis is important as treating TIA early can prevent subsequent strokes. Recent improvements in mass spectrometer technology allow quantification of hundreds of plasma proteins and lipids, yielding large datasets that would benefit from different approaches including machine learning. Using plasma protein, lipid and radiological biomarkers, our study will develop predictive algorithms to distinguish TIA from minor stroke (positive control) and TIA-mimics (negative control). Analysis including machine learning employs more sophisticated modelling, allowing non-linear interactions, adapting to datasets and enabling development of multiple specialised test-panels for identification and differentiation. METHODS AND ANALYSIS Patients attending the Emergency Department, Stroke Ward or TIA Clinic at the Royal Adelaide Hospital with TIA, minor stroke or TIA-like symptoms will be recruited consecutively by staff-alert for this prospective cohort study. Advanced neuroimaging will be performed for each participant, with images assessed independently by up to three expert neurologists. Venous blood samples will be collected within 48 hours of symptom onset. Plasma proteomic and lipid analysis will use advanced mass spectrometry (MS) techniques. Principal component analysis and hierarchical cluster analysis will be performed using MS software. Output files will be analysed for relative biomarker quantitative differences between the three groups. Differences will be assessed by linear regression, one-way analysis of variance, Kruskal-Wallis H-test, χ2 test or Fisher's exact test. Machine learning methods will also be applied including deep learning using neural networks. ETHICS AND DISSEMINATION Patients will provide written informed consent to participate in this grant-funded study. The Central Adelaide Local Health Network Human Research Ethics Committee approved this study (HREC/18/CALHN/384; R20180618). Findings will be disseminated through peer-reviewed publication and conferences; data will be managed according to our Data Management Plan (DMP2020-00062).
Collapse
Affiliation(s)
- Austin G Milton
- Stroke Research Programme, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Stephan Lau
- Faculty of Engineering, Computer and Mathematical Sciences, Australian Institute for Machine Learning, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Karlea L Kremer
- Adelaide Medical School, Stroke Research Programme, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Sushma R Rao
- Proteomics, Metabolomics and MS-imaging Core Facility, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Emilie Mas
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- SA Pathology - Genetics and Molecular Pathology, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Marten F Snel
- Proteomics, Metabolomics and MS-imaging Core Facility, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Paul J Trim
- Proteomics, Metabolomics and MS-imaging Core Facility, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Deeksha Sharma
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Stroke Research Programme, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Mark Jenkinson
- Faculty of Engineering, Computer and Mathematical Sciences, Australian Institute for Machine Learning, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erik Noschka
- Adelaide Medical School, Stroke Research Programme, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Monica Anne Hamilton-Bruce
- Stroke Research Programme, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Medical School, Stroke Research Programme, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Simon A Koblar
- Adelaide Medical School, Stroke Research Programme, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| |
Collapse
|
11
|
Vodencarevic A, Weingärtner M, Caro JJ, Ukalovic D, Zimmermann-Rittereiser M, Schwab S, Kolominsky-Rabas P. Prediction of Recurrent Ischemic Stroke Using Registry Data and Machine Learning Methods: The Erlangen Stroke Registry. Stroke 2022; 53:2299-2306. [PMID: 35360927 DOI: 10.1161/strokeaha.121.036557] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There have been multiple efforts toward individual prediction of recurrent strokes based on structured clinical and imaging data using machine learning algorithms. Some of these efforts resulted in relatively accurate prediction models. However, acquiring clinical and imaging data is typically possible at provider sites only and is associated with additional costs. Therefore, we developed recurrent stroke prediction models based solely on data easily obtained from the patient at home. METHODS Data from 384 patients with ischemic stroke were obtained from the Erlangen Stroke Registry. Patients were followed at 3 and 12 months after first stroke and then annually, for about 2 years on average. Multiple machine learning algorithms were applied to train predictive models for estimating individual risk of recurrent stroke within 1 year. Double nested cross-validation was utilized for conservative performance estimation and models' learning capabilities were assessed by learning curves. Predicted probabilities were calibrated, and relative variable importance was assessed using explainable artificial intelligence techniques. RESULTS The best model achieved the area under the curve of 0.70 (95% CI, 0.64-0.76) and relatively good probability calibration. The most predictive factors included patient's family and housing circumstances, rehabilitative measures, age, high calorie diet, systolic and diastolic blood pressures, percutaneous endoscopic gastrotomy, number of family doctor's home visits, and patient's mental state. CONCLUSIONS Developing fairly accurate models for individual risk prediction of recurrent ischemic stroke within 1 year solely based on registry data is feasible. Such models could be applied in a home setting to provide an initial risk assessment and identify high-risk patients early.
Collapse
Affiliation(s)
| | - Michael Weingärtner
- Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander University Erlangen-Nürnberg, Germany (M.W.)
| | - J Jaime Caro
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada (J.J.C.).,Health Policy, London School of Economics, United Kingdom (J.J.C.)
| | - Dubravka Ukalovic
- Computed Tomography, Siemens Healthcare GmbH, Forchheim, Germany (D.U.)
| | | | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Germany (S.S.)
| | - Peter Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health, Friedrich-Alexander University Erlangen-Nürnberg, Germany (P.K.-R.)
| |
Collapse
|
12
|
Artificial Neural Network Detects Hip Muscle Forces as Determinant for Harmonic Walking in People after Stroke. SENSORS 2022; 22:s22041374. [PMID: 35214276 PMCID: PMC8963097 DOI: 10.3390/s22041374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023]
Abstract
Many recent studies have highlighted that the harmony of physiological walking is based on a specific proportion between the durations of the phases of the gait cycle. When this proportion is close to the so-called golden ratio (about 1.618), the gait cycle assumes an autosimilar fractal structure. In stroke patients this harmony is altered, but it is unclear which factor is associated with the ratios between gait phases because these relationships are probably not linear. We used an artificial neural network to determine the weights associable to each factor for determining the ratio between gait phases and hence the harmony of walking. As expected, the gait ratio obtained as the ratio between stride duration and stance duration was found to be associated with walking speed and stride length, but also with hip muscle forces. These muscles could be important for exploiting the recovery of energy typical of the pendular mechanism of walking. Our study also highlighted that the results of an artificial neural network should be associated with a reliability analysis, being a non-deterministic approach. A good level of reliability was found for the findings of our study.
Collapse
|
13
|
Ma H, Huang G, Li M, Han Y, Sun J, Zhan L, Wang Q, Jia X, Han X, Li H, Song Y, Lv Y. The Predictive Value of Dynamic Intrinsic Local Metrics in Transient Ischemic Attack. Front Aging Neurosci 2022; 13:808094. [PMID: 35221984 PMCID: PMC8868122 DOI: 10.3389/fnagi.2021.808094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/30/2021] [Indexed: 12/19/2022] Open
Abstract
Background Transient ischemic attack (TIA) is known as “small stroke.” However, the diagnosis of TIA is currently difficult due to the transient symptoms. Therefore, objective and reliable biomarkers are urgently needed in clinical practice. Objective The purpose of this study was to investigate whether dynamic alterations in resting-state local metrics could differentiate patients with TIA from healthy controls (HCs) using the support-vector machine (SVM) classification method. Methods By analyzing resting-state functional MRI (rs-fMRI) data from 48 patients with and 41 demographically matched HCs, we compared the group differences in three dynamic local metrics: dynamic amplitude of low-frequency fluctuation (d-ALFF), dynamic fractional amplitude of low-frequency fluctuation (d-fALFF), and dynamic regional homogeneity (d-ReHo). Furthermore, we selected the observed alterations in three dynamic local metrics as classification features to distinguish patients with TIA from HCs through SVM classifier. Results We found that TIA was associated with disruptions in dynamic local intrinsic brain activities. Compared with HCs, the patients with TIA exhibited increased d-fALFF, d-fALFF, and d-ReHo in vermis, right calcarine, right middle temporal gyrus, opercular part of right inferior frontal gyrus, left calcarine, left occipital, and left temporal and cerebellum. These alternations in the dynamic local metrics exhibited an accuracy of 80.90%, sensitivity of 77.08%, specificity of 85.37%, precision of 86.05%, and area under curve of 0.8501 for distinguishing the patients from HCs. Conclusion Our findings may provide important evidence for understanding the neuropathology underlying TIA and strong support for the hypothesis that these local metrics have potential value in clinical diagnosis.
Collapse
Affiliation(s)
- Huibin Ma
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
- Integrated Medical School, Jiamusi University, Jiamusi, China
| | - Guofeng Huang
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Mengting Li
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Yu Han
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Jiawei Sun
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Linlin Zhan
- Faculty of Western Languages, Heilongjiang University, Harbin, China
| | - Qianqian Wang
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Xize Jia
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Huayun Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, China
- *Correspondence: Yulin Song,
| | - Yating Lv
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Yating Lv,
| |
Collapse
|
14
|
Artificial Intelligence: A Shifting Paradigm in Cardio-Cerebrovascular Medicine. J Clin Med 2021; 10:jcm10235710. [PMID: 34884412 PMCID: PMC8658222 DOI: 10.3390/jcm10235710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022] Open
Abstract
The future of healthcare is an organic blend of technology, innovation, and human connection. As artificial intelligence (AI) is gradually becoming a go-to technology in healthcare to improve efficiency and outcomes, we must understand our limitations. We should realize that our goal is not only to provide faster and more efficient care, but also to deliver an integrated solution to ensure that the care is fair and not biased to a group of sub-population. In this context, the field of cardio-cerebrovascular diseases, which encompasses a wide range of conditions-from heart failure to stroke-has made some advances to provide assistive tools to care providers. This article aimed to provide an overall thematic review of recent development focusing on various AI applications in cardio-cerebrovascular diseases to identify gaps and potential areas of improvement. If well designed, technological engines have the potential to improve healthcare access and equitability while reducing overall costs, diagnostic errors, and disparity in a system that affects patients and providers and strives for efficiency.
Collapse
|
15
|
Picerno P, Iosa M, D'Souza C, Benedetti MG, Paolucci S, Morone G. Wearable inertial sensors for human movement analysis: a five-year update. Expert Rev Med Devices 2021; 18:79-94. [PMID: 34601995 DOI: 10.1080/17434440.2021.1988849] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory- and ambulatory-based settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings. AREAS COVERED Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings. EXPERT OPINION IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.
Collapse
Affiliation(s)
- Pietro Picerno
- SMART Engineering Solutions & Technologies (SMARTEST) Research Center, Università Telematica "Ecampus", Novedrate, Comune, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza University, Rome, Italy.,Irrcs Santa Lucia Foundation, Rome, Italy
| | - Clive D'Souza
- Center for Ergonomics, Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | |
Collapse
|
16
|
Wang X, Zhong J, Lei T, Chen D, Wang H, Zhu L, Chu S, Liu L. An Artificial Neural Network Prediction Model for Posttraumatic Epilepsy: Retrospective Cohort Study. J Med Internet Res 2021; 23:e25090. [PMID: 34420931 PMCID: PMC8414301 DOI: 10.2196/25090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background Posttraumatic epilepsy (PTE) is a common sequela after traumatic brain injury (TBI), and identifying high-risk patients with PTE is necessary for their better treatment. Although artificial neural network (ANN) prediction models have been reported and are superior to traditional models, the ANN prediction model for PTE is lacking. Objective We aim to train and validate an ANN model to anticipate the risks of PTE. Methods The training cohort was TBI patients registered at West China Hospital. We used a 5-fold cross-validation approach to train and test the ANN model to avoid overfitting; 21 independent variables were used as input neurons in the ANN models, using a back-propagation algorithm to minimize the loss function. Finally, we obtained sensitivity, specificity, and accuracy of each ANN model from the 5 rounds of cross-validation and compared the accuracy with a nomogram prediction model built in our previous work based on the same population. In addition, we evaluated the performance of the model using patients registered at Chengdu Shang Jin Nan Fu Hospital (testing cohort 1) and Sichuan Provincial People’s Hospital (testing cohort 2) between January 1, 2013, and March 1, 2015. Results For the training cohort, we enrolled 1301 TBI patients from January 1, 2011, to December 31, 2017. The prevalence of PTE was 12.8% (166/1301, 95% CI 10.9%-14.6%). Of the TBI patients registered in testing cohort 1, PTE prevalence was 10.5% (44/421, 95% CI 7.5%-13.4%). Of the TBI patients registered in testing cohort 2, PTE prevalence was 6.1% (25/413, 95% CI 3.7%-8.4%). The results of the ANN model show that, the area under the receiver operating characteristic curve in the training cohort was 0.907 (95% CI 0.889-0.924), testing cohort 1 was 0.867 (95% CI 0.842-0.893), and testing cohort 2 was 0.859 (95% CI 0.826-0.890). Second, the average accuracy of the training cohort was 0.557 (95% CI 0.510-0.620), with 0.470 (95% CI 0.414-0.526) in testing cohort 1 and 0.344 (95% CI 0.287-0.401) in testing cohort 2. In addition, sensitivity, specificity, positive predictive values and negative predictors in the training cohort (testing cohort 1 and testing cohort 2) were 0.80 (0.83 and 0.80), 0.86 (0.80 and 0.84), 91% (85% and 78%), and 86% (80% and 83%), respectively. When calibrating this ANN model, Brier scored 0.121 in testing cohort 1 and 0.127 in testing cohort 2. Compared with the nomogram model, the ANN prediction model had a higher accuracy (P=.01). Conclusions This study shows that the ANN model can predict the risk of PTE and is superior to the risk estimated based on traditional statistical methods. However, the calibration of the model is a bit poor, and we need to calibrate it on a large sample size set and further improve the model.
Collapse
Affiliation(s)
- Xueping Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhong
- Department of Ophthalmology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Ting Lei
- Department of Neurosurgery, Shang Jin Nan Fu Hospital of West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lina Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shanshan Chu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW The European Stroke Organisation published a European Stroke Action Plan (SAP-E) for the years 2018-2030. The SAP-E addresses the entire chain of care from primary prevention through to life after stroke. Within this document digital health tools are suggested for their potential to facilitate greater access to stroke care. In this review, we searched for digital health solutions for every domain of the SAP-E. RECENT FINDINGS Currently available digital health solutions for the cerebrovascular disease have been designed to support professionals and patients in healthcare settings at all stages. Telemedicine in acute settings has notably increased the access to tissue plasminogen activator and thrombectomy whereas in poststroke settings it has improved access to rehabilitation. Moreover, numerous applications aim to monitor vital signs and prescribed treatment adherence. SUMMARY SAP-E with its seven domains covers the whole continuum of stroke care, where digital health solutions have been considered to provide utility at a low cost. These technologies are progressively being used in all phases of stroke care, allowing them to overcome geographical and organizational barriers. The commercially available applications may also be used by patients and their careers in various context to facilitate accessibility to health improvement strategies.
Collapse
|
18
|
Yeo M, Kok HK, Kutaiba N, Maingard J, Thijs V, Tahayori B, Russell J, Jhamb A, Chandra RV, Brooks M, Barras CD, Asadi H. Artificial intelligence in clinical decision support and outcome prediction - applications in stroke. J Med Imaging Radiat Oncol 2021; 65:518-528. [PMID: 34050596 DOI: 10.1111/1754-9485.13193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/29/2021] [Indexed: 01/19/2023]
Abstract
Artificial intelligence (AI) is making a profound impact in healthcare, with the number of AI applications in medicine increasing substantially over the past five years. In acute stroke, it is playing an increasingly important role in clinical decision-making. Contemporary advances have increased the amount of information - both clinical and radiological - which clinicians must consider when managing patients. In the time-critical setting of acute stroke, AI offers the tools to rapidly evaluate and consolidate available information, extracting specific predictions from rich, noisy data. It has been applied to the automatic detection of stroke lesions on imaging and can guide treatment decisions through the prediction of tissue outcomes and long-term functional outcomes. This review examines the current state of AI applications in stroke, exploring their potential to reform stroke care through clinical decision support, as well as the challenges and limitations which must be addressed to facilitate their acceptance and adoption for clinical use.
Collapse
Affiliation(s)
- Melissa Yeo
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Department of Radiology, Northern Health, Melbourne, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Julian Maingard
- School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Interventional Neuroradiology Unit, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Bahman Tahayori
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
- IBM Research Australia, Melbourne, Victoria, Australia
| | - Jeremy Russell
- Department of Neurosurgery, Austin Hospital, Melbourne, Victoria, Australia
| | - Ashu Jhamb
- Department of Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mark Brooks
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Christen D Barras
- South Australian Institute of Health and Medical Research, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hamed Asadi
- School of Medicine, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Interventional Neuroradiology Unit, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Department of Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia
- Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Iosa M, Capodaglio E, Pelà S, Persechino B, Morone G, Antonucci G, Paolucci S, Panigazzi M. Artificial Neural Network Analyzing Wearable Device Gait Data for Identifying Patients With Stroke Unable to Return to Work. Front Neurol 2021; 12:650542. [PMID: 34093396 PMCID: PMC8170310 DOI: 10.3389/fneur.2021.650542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
A potential dramatic effect of long-term disability due to stroke is the inability to return to work. An accurate prognosis and the identification of the parameters inflating the possibility of return to work after neurorehabilitation are crucial. Many factors may influence it, such as mobility and, in particular, walking ability. In this pilot study, two emerging technologies have been combined with the aim of developing a prognostic tool for identifying patients able to return to work: a wearable inertial measurement unit for gait analysis and an artificial neural network (ANN). Compared with more conventional statistics, the ANN showed a higher accuracy in identifying patients with respect to healthy subjects (90.9 vs. 75.8%) and also in identifying the subjects unable to return to work (93.9 vs. 81.8%). In this last analysis, the duration of double support phase resulted the most important input of the ANN. The potentiality of the ANN, developed also in other fields such as marketing on social networks, could allow a powerful support for clinicians that today should manage a large amount of instrumentally recorded parameters in patients with stroke.
Collapse
Affiliation(s)
- Marco Iosa
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Edda Capodaglio
- Occupational Therapy and Ergonomics Unit, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy
| | - Silvia Pelà
- Occupational Therapy and Ergonomics Unit, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy
| | - Benedetta Persechino
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Giovanni Morone
- Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Monica Panigazzi
- Occupational Therapy and Ergonomics Unit, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy.,Occupational Therapy and Ergonomics Unit, Istituti Clinici Scientifici Maugeri IRCSS, Montescano, Italy
| |
Collapse
|
20
|
Artificial neural network based prediction of postthrombolysis intracerebral hemorrhage and death. Sci Rep 2020; 10:20501. [PMID: 33239681 PMCID: PMC7689530 DOI: 10.1038/s41598-020-77546-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/09/2020] [Indexed: 01/25/2023] Open
Abstract
Despite the salient benefits of the intravenous tissue plasminogen activator (tPA), symptomatic intracerebral hemorrhage (sICH) remains a frequent complication and constitutes a major concern when treating acute ischemic stroke (AIS). This study explored the use of artificial neural network (ANN)-based models to predict sICH and 3-month mortality for patients with AIS receiving tPA. We developed ANN models based on evaluation of the predictive value of pre-treatment parameters associated with sICH and mortality in a cohort of 331 patients between 2009 and 2018. The ANN models were generated using eight clinical inputs and two outputs. The generalizability of the model was validated using fivefold cross-validation. The performance of each model was assessed according to the accuracy, precision, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). After adequate training, the ANN predictive model AUC for sICH was 0.941, with accuracy, sensitivity, and specificity of 91.0%, 85.7%, and 92.5%, respectively. The predictive model AUC for 3-month mortality was 0.976, with accuracy, sensitivity, and specificity of 95.2%, 94.4%, and 95.5%, respectively. The generated ANN-based models exhibited high predictive performance and reliability for predicting sICH and 3-month mortality after thrombolysis; thus, its clinical application to assist decision-making when administering tPA is envisaged.
Collapse
|
21
|
Khan A, Akhtar N, Kamran S, Almuhannadi H, Ponirakis G, Petropoulos IN, Babu B, Jose NR, Ibrahim RG, Gad H, Bourke P, Saqqur M, Shuaib A, Malik RA. Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke. PLoS One 2020; 15:e0231987. [PMID: 32320450 PMCID: PMC7176137 DOI: 10.1371/journal.pone.0231987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives Corneal nerve damage may be a surrogate marker for the risk of ischemic stroke. This study was undertaken to determine if there is greater corneal nerve damage in patients with recurrent ischemic stroke. Methods Corneal confocal microscopy (CCM) was used to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and corneal nerve fiber tortuosity (CNFT) in 31 patients with recurrent ischemic stroke, 165 patients with a first acute ischemic stroke and 23 healthy control subjects. Results Triglycerides (P = 0.004, P = 0.017), systolic BP (P = 0.000, P = 0.000), diastolic BP (P = 0.000, P = 0.000) and HbA1c (P = 0.000, P = 0.000) were significantly higher in patients with first and recurrent stroke compared to controls. There was no difference in age, BMI, HbA1c, total cholesterol, triglycerides, LDL, HDL, systolic and diastolic BP between patients with a first and recurrent ischemic stroke. However, CNFD was significantly lower (24.98±7.31 vs 29.07±7.58 vs 37.91±7.13, P<0.05) and CNFT was significantly higher (0.085±0.042 vs 0.064±0.037 vs 0.039±0.022, P<0.05) in patients with recurrent stroke compared to first stroke and healthy controls. CNBD (42.21±24.65 vs 50.46±27.68 vs 87.24±45.85, P<0.001) and CNFL (15.66±5.70, P<0.001 vs 17.38±5.06, P = 0.003) were equally reduced in patients with first and recurrent stroke compared to controls (22.72±5.14). Conclusions Corneal confocal microscopy identified greater corneal nerve fibre loss in patients with recurrent stroke compared to patients with first stroke, despite comparable risk factors. Longitudinal studies are required to determine the prognostic utility of corneal nerve fiber loss in identifying patients at risk of recurrent ischemic stroke.
Collapse
Affiliation(s)
- Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Blessy Babu
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Namitha R. Jose
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Rumissa G. Ibrahim
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Paula Bourke
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- * E-mail:
| |
Collapse
|
22
|
|
23
|
Chung CC, Hong CT, Huang YH, Su ECY, Chan L, Hu CJ, Chiu HW. Predicting major neurologic improvement and long-term outcome after thrombolysis using artificial neural networks. J Neurol Sci 2020; 410:116667. [DOI: 10.1016/j.jns.2020.116667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
|
24
|
Chaudhary D, Abedi V, Li J, Schirmer CM, Griessenauer CJ, Zand R. Clinical Risk Score for Predicting Recurrence Following a Cerebral Ischemic Event. Front Neurol 2019; 10:1106. [PMID: 31781015 PMCID: PMC6861423 DOI: 10.3389/fneur.2019.01106] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction: Recurrent stroke has a higher rate of death and disability. A number of risk scores have been developed to predict short-term and long-term risk of stroke following an initial episode of stroke or transient ischemic attack (TIA) with limited clinical utilities. In this paper, we review different risk score models and discuss their validity and clinical utilities. Methods: The PubMed bibliographic database was searched for original research articles on the various risk scores for risk of stroke following an initial episode of stroke or TIA. The validation of the models was evaluated by examining the internal and external validation process as well as statistical methodology, the study power, as well as the accuracy and metrics such as sensitivity and specificity. Results: Different risk score models have been derived from different study populations. Validation studies for these risk scores have produced conflicting results. Currently, ABCD2 score with diffusion weighted imaging (DWI) and Recurrence Risk Estimator at 90 days (RRE-90) are the two acceptable models for short-term risk prediction whereas Essen Stroke Risk Score (ESRS) and Stroke Prognosis Instrument-II (SPI-II) can be useful for prediction of long-term risk. Conclusion: The clinical risk scores that currently exist for predicting short-term and long-term risk of recurrent cerebral ischemia are limited in their performance and clinical utilities. There is a need for a better predictive tool which can overcome the limitations of current predictive models. Application of machine learning methods in combination with electronic health records may provide platform for development of new-generation predictive tools.
Collapse
Affiliation(s)
- Durgesh Chaudhary
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States.,Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States
| | - Clemens M Schirmer
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| |
Collapse
|
25
|
Patel UK, Anwar A, Saleem S, Malik P, Rasul B, Patel K, Yao R, Seshadri A, Yousufuddin M, Arumaithurai K. Artificial intelligence as an emerging technology in the current care of neurological disorders. J Neurol 2019; 268:1623-1642. [PMID: 31451912 DOI: 10.1007/s00415-019-09518-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Artificial intelligence (AI) has influenced all aspects of human life and neurology is no exception to this growing trend. The aim of this paper is to guide medical practitioners on the relevant aspects of artificial intelligence, i.e., machine learning, and deep learning, to review the development of technological advancement equipped with AI, and to elucidate how machine learning can revolutionize the management of neurological diseases. This review focuses on unsupervised aspects of machine learning, and how these aspects could be applied to precision neurology to improve patient outcomes. We have mentioned various forms of available AI, prior research, outcomes, benefits and limitations of AI, effective accessibility and future of AI, keeping the current burden of neurological disorders in mind. DISCUSSION The smart device system to monitor tremors and to recognize its phenotypes for better outcomes of deep brain stimulation, applications evaluating fine motor functions, AI integrated electroencephalogram learning to diagnose epilepsy and psychological non-epileptic seizure, predict outcome of seizure surgeries, recognize patterns of autonomic instability to prevent sudden unexpected death in epilepsy (SUDEP), identify the pattern of complex algorithm in neuroimaging classifying cognitive impairment, differentiating and classifying concussion phenotypes, smartwatches monitoring atrial fibrillation to prevent strokes, and prediction of prognosis in dementia are unique examples of experimental utilizations of AI in the field of neurology. Though there are obvious limitations of AI, the general consensus among several nationwide studies is that this new technology has the ability to improve the prognosis of neurological disorders and as a result should become a staple in the medical community. CONCLUSION AI not only helps to analyze medical data in disease prevention, diagnosis, patient monitoring, and development of new protocols, but can also assist clinicians in dealing with voluminous data in a more accurate and efficient manner.
Collapse
Affiliation(s)
- Urvish K Patel
- Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
| | - Arsalan Anwar
- Department of Neurology, UH Cleveland Medical Center, Cleveland, OH, USA
| | - Sidra Saleem
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Preeti Malik
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bakhtiar Rasul
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karan Patel
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Yao
- Department of Biomedical Informatics, Arizona State University and Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ashok Seshadri
- Department of Psychiatry, Mayo Clinic Health System, Rochester, MN, USA
| | | | | |
Collapse
|