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In Neurosurgery ; h5-index 55.0

BACKGROUND : Current prognostic tools in aneurysmal subarachnoid hemorrhage (aSAH) are constrained by being primarily based on patient and disease characteristics on admission.

OBJECTIVE : To develop and validate a complication- and treatment-aware outcome prediction tool in aSAH.

METHODS : This 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.

RESULTS : Favorable 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.

CONCLUSION : Both 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.

Maldaner Nicolai, Zeitlberger Anna M, Sosnova Marketa, Goldberg Johannes, Fung Christian, Bervini David, May Adrien, Bijlenga Philippe, Schaller Karl, Roethlisberger Michel, Rychen Jonathan, Zumofen Daniel W, D’Alonzo Donato, Marbacher Serge, Fandino Javier, Daniel Roy Thomas, Burkhardt Jan-Karl, Chiappini Alessio, Robert Thomas, Schatlo Bawarjan, Schmid Josef, Maduri Rodolfo, Staartjes Victor E, Seule Martin A, Weyerbrock Astrid, Serra Carlo, Stienen Martin Nikolaus, Bozinov Oliver, Regli Luca


Aneurysmal subarachnoid hemorrhage, Complication- and treatment-aware, Machine learning, Outcome prediction