Predicting the outcome of patients with subarachnoid hemorrhage using machine learning techniques

Background: Outcome prediction for subarachnoid hemorrhage (SAH) helps guide care and compare global management strategies. Logistic regression models for outcome prediction may be cumbersome to apply in clinical practice. Objective: To use machine learning techniques to build a model of outcome prediction that makes the knowledge discovered from the data explicit and communicable to domain experts. Material and methods: A derivation cohort (n = 441) of nonselected SAH cases was analyzed using different classification algorithms to generate decision trees and decision rules. Algorithms used were C4.5, fast decision tree learner, partial decision trees, repeated incremental pruning to produce error reduction, nearest neighbor with generalization, and ripple down rule learner. Outcome was dichotomized in favorable [Glasgow outcome scale (GOS) = I–II] and poor (GOS = III–V). An independent cohort (n = 193) was used for validation. An exploratory questionnaire was given to potential users (specialist doctors) to gather their opinion on the classifier and its usability in clinical routine. Results: The best classifier was obtained with the C4.5 algorithm. It uses only two attributes [World Federation of Neurological Surgeons (WFNS) and Fisher’s scale] and leads to a simple decision tree. The accuracy of the classifier [area under the ROC curve (AUC) = 0.84; confidence interval (CI) = 0.80–0.88] is similar to that obtained by a logistic regression model (AUC = 0.86; CI = 0.83–0.89) derived from the same data and is considered better fit for clinical use.This work was supported in part by the Spanish Ministries of Science under Grant TRA2007-67374-C02-02 and Health under Grant FIS PI 070152. The work of A. Lagares and J.F. Alen was supported by the Fundación Mutua Madrileña