Toward Grading Subarachnoid Hemorrhage Risk Prediction: A Machine Learning-based Aneurysm Rupture Score

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World Neurosurg


BACKGROUND: Existing approaches neither provide an accurate prediction of subarachnoid hemorrhage (SAH) nor offer a quantitative comparison among a group of its risk factors.

OBJECTIVE: To evaluate the PHASES and UIATS scores and develop an Artificial Intelligence-based 5-year and lifetime aneurysmal rupture criticality prediction (ARCP) score for a set of risk factors.

METHODS: We design various location- specific and ensemble learning models to develop lifetime rupture risk, employ the longitudinal data to develop a linear regression-based model to predict an aneurysm's growth score, and use the Apriori algorithm to identify risk factors strongly associated with SAH. We develop ARCP by integrating output of Apriori algorithm and ML models and compare with PHASES and UIATS scores along with the scores of a multidisciplinary team of neurosurgeons.

RESULTS: The PHASES and UIATS scores show sensitivities of 22%, and 35%, and specificities of 76% and 79%, respectively. Location-specific models show precision and recall of 93% and 90% for the Middle Cerebral Artery, 83% and 80% for the Anterior Communicating Artery, and 80% and 80% for the Supraclinoid Internal Carotid Artery. The ensemble method shows both precision and recall of 80%. The validation of the models shows that ARCP performs better than our control group of neurosurgeons. Data-driven knowledge produces comparisons among 61 risk factor combinations, 11 ranked minor, 8 moderate, 41 severe, and one of which is a critical factor.

CONCLUSION: The PHASES and UIATS are weak predictors, and the ARCP score can identify, and grade, risk factors associated with SAH.

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ePub ahead of print