• Nicolai Maldaner, Anna M Zeitlberger, Marketa Sosnova, Johannes Goldberg, Christian Fung, David Bervini, Adrien May, Philippe Bijlenga, Karl Schaller, Michel Roethlisberger, Jonathan Rychen, Daniel W Zumofen, Donato D'Alonzo, Serge Marbacher, Javier Fandino, Roy Thomas Daniel, Jan-Karl Burkhardt, Alessio Chiappini, Thomas Robert, Bawarjan Schatlo, Josef Schmid, Rodolfo Maduri, Victor E Staartjes, Martin A Seule, Astrid Weyerbrock, Carlo Serra, Martin Nikolaus Stienen, Oliver Bozinov, and Luca Regli.
• Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
• Neurosurgery. 2021 Jan 13; 88 (2): E150-E157.

BackgroundCurrent prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission.ObjectiveTo develop and validate a complication- and treatment-aware outcome prediction tool in aSAH.MethodsThis cohort study included data from an ongoing prospective nationwide multicenter registry on all aSAH patients in Switzerland (Swiss SOS [Swiss Study on aSAH]; 2009-2015). We trained supervised machine learning algorithms to predict a binary outcome at discharge (modified Rankin scale [mRS] ≤ 3: favorable; mRS 4-6: unfavorable). Clinical and radiological variables on admission ("Early" Model) as well as additional variables regarding secondary complications and disease management ("Late" Model) were used. Performance of both models was assessed by classification performance metrics on an out-of-sample test dataset.ResultsFavorable functional outcome at discharge was observed in 1156 (62.0%) of 1866 patients. Both models scored a high accuracy of 75% to 76% on the test set. The "Late" outcome model outperformed the "Early" model with an area under the receiver operator characteristics curve (AUC) of 0.85 vs 0.79, corresponding to a specificity of 0.81 vs 0.70 and a sensitivity of 0.71 vs 0.79, respectively.ConclusionBoth machine learning models show good discrimination and calibration confirmed on application to an internal test dataset of patients with a wide range of disease severity treated in different institutions within a nationwide registry. Our study indicates that the inclusion of variables reflecting the clinical course of the patient may lead to outcome predictions with superior predictive power compared to a model based on admission data only.Copyright © 2020 by the Congress of Neurological Surgeons.

20 keywords...

hide…