Key result
The DAMS machine learning model, based on a support vector machine algorithm, effectively predicted post-stroke disability in mild stroke patients with an AUC of 0.762, outperforming traditional THRIVE and HIAT scores.
Why the study?
Treatment for mild stroke remains an open question, prompting the development of a machine learning-based decision support tool to identify patients at high risk of post-stroke disability receiving only medical therapy.
Can a machine learning-based decision support tool accurately predict 3-month post-stroke disability in patients with mild ischemic stroke?
Cohort (n=1,905)
No
Can a machine learning-based decision support tool accurately predict 3-month post-stroke disability in patients with mild ischemic stroke?
Effect estimate: AUC 0.762 (95% CI 0.705-0.819)
Absolute Event Rate: 0.762% vs 0.633%
A machine learning model (DAMS) using emergency context variables, particularly admission NIHSS, can effectively predict 3-month post-stroke disability in mild stroke patients.
May aid emergency risk stratification in mild stroke; leaves open prospective validation before clinical adoption.
Background and Purpose: Treatment for mild stroke remains an open question. We aim to develop a decision support tool based on machine learning (ML) algorithms, called DAMS (Disability After Mild Stroke), to identify mild stroke patients who would be at high risk of post-stroke disability (PSD) if they only received medical therapy and, more importantly, to aid neurologists in making individual clinical decisions in emergency contexts. Methods: Ischemic stroke patients were prospectively recorded in the National Advanced Stroke Center of Nanjing First Hospital (China) between July 2016 and September 2020. The exclusion criteria were patients who received thrombolytic therapy, age <18 years, lack of 3-month modified Rankin Scale (mRS), disabled before the index stroke, with an admission National Institute of Health stroke scale (NIHSS) > 5. The primary outcome was PSD, corresponding to 3-month mRS ≥ 2. We developed five ML models and assessed the area under curve (AUC) of receiver operating characteristic, calibration curve, and decision curve analysis. The optimal ML model was selected to be DAMS. In addition, SHapley Additive exPlanations (SHAP) approach was introduced to rank the feature importance. Finally, rapid-DAMS (R-DAMS) was constructed for a more urgent situation based on DAMS. Results: A total of 1,905 mild stroke patients were enrolled in this study, and patients with PSD accounted for 23.4% (447). There was no difference in AUCs between the five models (ranged from 0.691 to 0.823). Although there was similar discriminative performance between ML models, the support vector machine model exhibited higher net benefit and better calibration (Brier score, 0.159, calibration slope, 0.935, calibration intercept, 0.035). Therefore, this model was selected for DAMS. In addition, SHAP approach showed that the most crucial feature was NIHSS on admission. Finally, R-DAMS was constructed and there was similar discriminative performance between R-DAMS and DAMS, but the former performed worse on calibration. Conclusions: DAMS and R-DAMS, as prediction-driven decision support tools, were designed to aid clinical decision-making for mild stroke patients in emergency contexts. In addition, even within a narrow range of baseline scores, NIHSS on admission is the strongest feature that contributed to the prediction.
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Lin et al. (2021) conducted a cohort in Mild ischemic stroke (n=1,905). DAMS (Disability After Mild Stroke) machine learning model vs. THRIVE and HIAT scores was evaluated on Prediction of post-stroke disability (3-month mRS ≥ 2) (AUC 0.762, 95% CI 0.705-0.819). The DAMS machine learning model, based on a support vector machine algorithm, effectively predicted post-stroke disability in mild stroke patients with an AUC of 0.762, outperforming traditional THRIVE and HIAT scores.
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