An artificial neural network model significantly outperformed other machine learning algorithms in predicting 30-day readmission after stroke, achieving an area under the curve of 0.89.
Cohort (n=1,476)
Yes
Does an artificial neural network (ANN) model improve prediction of 30-day readmission in patients with stroke compared to other machine learning models?
An artificial neural network model accurately predicts 30-day readmission in stroke patients, outperforming other machine learning models and identifying post-acute care participation as a key predictor.
Effect estimate: AUC 0.89 (95% CI 0.85-0.93)
p-value: p=<0.001
Background Machine learning algorithms for predicting 30-day stroke readmission are rarely discussed. The aims of this study were to identify significant predictors of 30-day readmission after stroke and to compare prediction accuracy and area under the receiver operating characteristic (AUROC) curve in five models: artificial neural network (ANN), K nearest neighbor (KNN), random forest (RF), support vector machine (SVM), naive Bayes classifier (NBC), and Cox regression (COX) models. Methods The subjects of this prospective cohort study were 1,476 patients with a history of admission for stroke to one of six hospitals between March, 2014, and September, 2019. A training dataset ( n = 1,033) was used for model development, and a testing dataset ( n = 443) was used for internal validation. Another 167 patients with stroke recruited from October, to December, 2019, were enrolled in the dataset for external validation. A feature importance analysis was also performed to identify the significance of the selected input variables. Results For predicting 30-day readmission after stroke, the ANN model had significantly ( P 0.001) higher performance indices compared to the other models. According to the ANN model results, the best predictor of 30-day readmission was PAC followed by nasogastric tube insertion and stroke type ( P 0.05). Using a machine learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients. Conclusion Using a machine-learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients. For stroke patients who are candidates for PAC rehabilitation, these predictors have practical applications in educating patients in the expected course of recovery and health outcomes.
Chen et al. (Mon,) conducted a cohort in Stroke (n=1,476). Artificial neural network (ANN) model vs. Other machine learning models (KNN, RF, SVM, NBC, COX) was evaluated on Area under the receiver operating characteristic (AUROC) curve for predicting 30-day readmission (testing dataset) (AUC 0.89, 95% CI 0.85-0.93, p=<0.001). An artificial neural network model significantly outperformed other machine learning algorithms in predicting 30-day readmission after stroke, achieving an area under the curve of 0.89.