Dynamic Detection of Delayed Cerebral Ischemia Using Machine Learning

Objective: To develop a machine learning based tool, using routine vital signs, to assess delayed cerebral ischemia (DCI) risk over time. Methods: In this retrospective analysis, physiologic data for 540 consecutive acute subarachnoid hemorrhage patients were collected and annotated as part of a prospective observational cohort study between May 2006 and December 2014. Patients were excluded if (i) no physiologic data was available, (ii) they expired prior to the DCI onset window (< post bleed day 3) or (iii) early angiographic vasospasm was detected on admitting angiogram. DCI was prospectively labeled by consensus of treating physicians. Occurrence of DCI was classified using various machine learning approaches including logistic regression, random forest, support vector machine (linear and kernel), and an ensemble classifier, trained on vitals and subject characteristic features. Hourly risk scores were generated as the posterior probability at time t. We performed five-fold nested cross validation to tune the model parameters and to report the accuracy. All classifiers were evaluated for good discrimination using the area under the receiver operating characteristic curve (AU-ROC) and confusion matrices. Results: Of 310 patients included in our final analysis, 101 (32.6%) patients developed DCI. We achieved maximal classification of 0.81 [0.75-0.82] AU-ROC. We also predicted 74.7 % of all DCI events 12 hours before typical clinical detection with a ratio of 3 true alerts for every 2 false alerts. Conclusion: A data-driven machine learning based detection tool offered hourly assessments of DCI risk and incorporated new physiologic information over time.