Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury
Journal of Clinical Epidemiology, vol. 122, pp. 95–107
Abstract
OBJECTIVE: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. STUDY DESIGN AND SETTING: We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. RESULTS: In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. CONCLUSION: ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations.
Authors 96
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Benjamin Yaël Gravesteijn corresponding
Affiliation as printed
Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands. Electronic address: b.gravesteijn@erasmusmc.nl
Departments of Public Health, Erasmus MC – University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
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Affiliation as printed
Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
Departments of Public Health, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, the Netherlands
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University of Cambridge · Cambridge University Press · Addenbrooke's Hospital
Affiliation as printed
Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
Addenbrooke's Hospital (CB2 2QQ;Cambridge - United Kingdom)
CAM - University of Cambridge [UK] (The Old Schools, Trinity Lane, Cambridge CB2 1TN - United Kingdom)
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Affiliation as printed
Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
Erasmus MC - Erasmus University Medical Center [Rotterdam] (Rotterdam - Netherlands)
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Karolinska Institutet · University of Tennessee at Knoxville
Affiliation as printed
Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
University of Tennessee (United States)
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Ben Van Calster Aachen
Leiden University · Leiden University Medical Center · KU Leuven
Affiliation as printed
Department of Development and Regeneration, KU Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven (Oude Markt 13 - bus 5005, 3000 Leuven - Belgium)
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Ewout Willem Steyerberg Aachen
Leiden University · Leiden University Medical Center · Erasmus MC
Affiliation as printed
Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
LUMC - Leiden University Medical Center (Leids Universitair Medisch Centrum, Universiteit Leiden - 1233 ZA, Leiden - Netherlands)
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Affiliation as printed
Department of Physiology and Pharmacology , Section of Perioperative Medicine and Intensive Care , Karolinska Institutet , Stockholm , Sweden
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , P ecs , Hungary
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Affiliation as printed
Division of Surgery and Clinical Neuroscience ,
Oslo University Hospital [Oslo] (Kirkeveien 166, 0450 Oslo - Norway)
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University Hospital of North Norway
Affiliation as printed
Department of Neurosurgery , University Hospital Northern Norway , Tromso , Norway
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University Hospital of North Norway · UiT The Arctic University of Norway
Affiliation as printed
Department of Physical Medicine and Rehabilitation , University Hospital Northern Norway , Tromso , Norway
UiT - University of Tromsø (The Arctic University of Norway, PO Box 6050, Langnes 9037 Tromsø - Norway)
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Affiliation as printed
Trauma Surgery , Medical University Vienna , Vienna , Austria
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Centre Hospitalier Régional et Universitaire de Nancy · Université de Lorraine
Affiliation as printed
Department of Anesthesiology & Intensive Care , Uni- versity Hospital Nancy , Nancy , France
Service d'Anesthésie et Réanimation [CHRU Nancy] (29 avenue du Maréchal de Lattre de Tassigny, C.O. n°34, 54035 Nancy Cedex - France)
UL - Université de Lorraine (34 cours Léopold - CS 25233 - 54052 Nancy cedex - France)
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Université de Versailles Saint-Quentin-en-Yvelines · Assistance Publique – Hôpitaux de Paris · Hôpital André Mignot · Hôpital Raymond-Poincaré
Affiliation as printed
Raymond Poincare hospital , Assistance PubliqueeHopitaux de Paris , Paris , France
HANDIReSP - Laboratoire de recherches cliniques et en santé publique sur les handicaps psychique, cognitif et moteur (Hôpital Mignot 177 rue de Versailles 78157 Le Chesnay - France)
Hôpital Raymond Poincaré [AP-HP] (104 Boulevard Raymond Poincaré, 92380 Garches - France)
UVSQ Santé - UFR Sciences de la santé Simone Veil (2 avenue de la Source de la Bièvre - 78180 Montigny-le-Bretonneux - France)
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Affiliation as printed
Department of Anesthesiology & Intensive Care , S Raffaele University Hospital , Milan , Italy
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Radboud University Medical Center
Affiliation as printed
Department of Neurosurgery , Radboud University Medical Center , Nijmegen , The Netherlands
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Affiliation as printed
International Projects Management , ARTTIC , Mun- chen , Germany
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Neurology , Neurological Intensive Care Unit , Medical University of Innsbruck , Innsbruck , Austria
IMU - Innsbruck Medical University = Medizinische Universität Innsbruck (Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck - Austria)
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Karolinska University Hospital
Affiliation as printed
Department of Neurosurgery & Anesthesia & inten- sive care medicine , Karolinska University Hospital , Stock- holm , Sweden
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NIHR Surgical Reconstruction and Microbiology Research Centre
Affiliation as printed
NIHR Surgical Reconstruction and Microbiology Research Centre , Birmingham , UK
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Assistance Publique – Hôpitaux de Paris
Affiliation as printed
Anesthesie-R eanimation , Assistance PubliqueeHopitaux de Paris , Paris , France
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Azienda Ospedaliera Citta' della Salute e della Scienza di Torino · University of Turin
Affiliation as printed
Department of Anesthesia & ICU , AOU Citt a della Salute e della Scienza di TorinoeOrthopedic and Trauma Center , Torino , Italy
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Affiliation as printed
Department of Anesthesiology & Intensive Care , S Raffaele University Hospital , Milan , Italy
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Affiliation as printed
Department of Neurology , Odense University Hospi- tal , Odense , Denmark
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Innsbruck Medical University · Universität Innsbruck · Monash University
Affiliation as printed
BehaviourWorks Australia , Monash Sustainability Institute , Monash University , Victoria , Australia
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
Institute of Medical Psychology and Medical Sociol-ogy, Universit€ atsmedizin G€ ottingen, G€ ottingen, Germany
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Affiliation as printed
Department of Public Health , Faculty of Health Sci- ences and Social Work , Trnava University , Trnava , Slovakia
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Affiliation as printed
Quesgen Systems Inc. , Burlingame , California , USA
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Affiliation as printed
Australian &
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Affiliation as printed
Department of Neurosurgery , Medical School , Univer- sity of P ecs , Hungary and Neurotrauma Research Group ,
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University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of Medical Psychology , Universit€ atsklini- kum Hamburg-Eppendorf , Hamburg , Germany
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University of Cambridge · Rambam Health Care Campus · Addenbrooke's Hospital
Affiliation as printed
Brain Physics Lab , Division of Neurosurgery , Dept of Clinical Neurosciences , University of Cambridge , Adden- brooke's Hospital , Cambridge , UK
Department of Neurosurgery, Rambam Medical Cen-ter, Haifa, Israel
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Neuro ICU , Fondazione IRCCS C a Granda Ospedale Maggiore Policlinico , Milan , Italy. 103
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Neuro ICU , Fondazione IRCCS C a Granda Ospedale Maggiore Policlinico , Milan , Italy. 103
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Affiliation as printed
Department of Anesthesiology & Intensive Care , S Raffaele University Hospital , Milan , Italy
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Innsbruck Medical University · Universität Innsbruck · Monash University
Affiliation as printed
ANZIC Research Centre , Monash University , Depart- ment of Epidemiology and Preventive Medicine , Melbourne , Victoria , Australia
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
Institute of Medical Psychology and Medical Sociol-ogy, Universit€ atsmedizin G€ ottingen, G€ ottingen, Germany
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Affiliation as printed
Department of Neurosurgery , Hospital of Cruces , Bil- bao , Spain
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Neuro ICU , Fondazione IRCCS C a Granda Ospedale Maggiore Policlinico , Milan , Italy. 103
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Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Affiliation as printed
NeuroIntensive Care , Niguarda Hospital , Milan , Italy
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Azienda Ospedaliera San Gerardo · University of Milano-Bicocca
Affiliation as printed
NeuroIntensive Care , ASST di Monza , Monza , Italy
School of Medicine and Surgery , Universit a Milano Bicocca , Milano , Italy
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Affiliation as printed
Department of Public Health , Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands
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Cambridge University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Anesthesia & Neurointensive Care , Cambridge University Hospital NHS Foundation Trust , Cambridge , UK
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Affiliation as printed
School of Public Health & PM , Monash University and
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MRC Cognition and Brain Sciences Unit
Affiliation as printed
Radiology/MRI department , MRC Cognition and Brain Sciences Unit , Cambridge , UK
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Oxford University Hospitals NHS Trust
Affiliation as printed
Oxford University Hospitals NHS Trust , Oxford , UK
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Affiliation as printed
Department of Neurosurgery , Medical School , Univer- sity of P ecs , Hungary and Neurotrauma Research Group ,
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University of Cambridge · Addenbrooke's Hospital
Affiliation as printed
Brain Physics Lab , Division of Neurosurgery , Dept of Clinical Neurosciences , University of Cambridge , Adden- brooke's Hospital , Cambridge , UK
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Centre Hospitalier Universitaire de Poitiers
Affiliation as printed
Intensive Care Unit , CHU Poitiers
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Affiliation as printed
New Zealand Intensive Care Research Centre , Department of Epidemiology and Preventive Med- icine , School of Public Health and Preventive Medicine ,
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Assistance Publique – Hôpitaux de Paris
Affiliation as printed
Anesthesie-R eanimation , Assistance PubliqueeHopitaux de Paris , Paris , France
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Affiliation as printed
New Zealand Intensive Care Research Centre , Department of Epidemiology and Preventive Med- icine , School of Public Health and Preventive Medicine ,
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Radboud University Medical Center
Affiliation as printed
Department of Neurosurgery , Radboud University Medical Center , Nijmegen , The Netherlands
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
New Zealand Intensive Care Research Centre , Department of Epidemiology and Preventive Med- icine , School of Public Health and Preventive Medicine ,
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Affiliation as printed
Australian &
Department of Neurosurgery, Rambam Medical Cen-ter, Haifa, Israel
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
New Zealand Intensive Care Research Centre , Department of Epidemiology and Preventive Med- icine , School of Public Health and Preventive Medicine ,
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University Hospital Heidelberg · Monash University
Affiliation as printed
Monash University , Melbourne , Australia
Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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Affiliation as printed
Monash University , Melbourne , Australia
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Assistance Publique – Hôpitaux de Paris
Affiliation as printed
Anesthesie-R eanimation , Assistance PubliqueeHopitaux de Paris , Paris , France
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Affiliation as printed
ANZIC Research Centre , Monash University , Depart- ment of Epidemiology and Preventive Medicine , Melbourne , Victoria , Australia
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
Monash University , Melbourne , Australia
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Leiden University · Leiden University Medical Center · University of Pecs · KU Leuven
Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
Department of Development and Regeneration, KU Leuven, Belgium
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
Department of Public Health , Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Neurology , Neurological Intensive Care Unit , Medical University of Innsbruck , Innsbruck , Austria
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
Department of Public Health , Erasmus Medical Center-University Medical Center , Rotterdam , The Netherlands
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Innsbruck Medical University · Universität Innsbruck · MRC Cognition and Brain Sciences Unit · University of Pecs
Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
Radiology/MRI department, MRC Cognition and Brain Sciences Unit, Cambridge, UK
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Affiliation as printed
Monash University , Melbourne , Australia
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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Affiliation as printed
J anos Szent agothai Research Centre , University of P ecs , Hungary
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