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      Predicting cerebral edema in patients with spontaneous intracerebral hemorrhage using machine learning

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          Abstract

          Background

          The early prediction of cerebral edema changes in patients with spontaneous intracerebral hemorrhage (SICH) may facilitate earlier interventions and result in improved outcomes. This study aimed to develop and validate machine learning models to predict cerebral edema changes within 72 h, using readily available clinical parameters, and to identify relevant influencing factors.

          Methods

          An observational study was conducted between April 2021 and October 2023 at the Quzhou Affiliated Hospital of Wenzhou Medical University. After preprocessing the data, the study population was randomly divided into training and internal validation cohorts in a 7:3 ratio (training: N = 150; validation: N = 65). The most relevant variables were selected using Support Vector Machine Recursive Feature Elimination (SVM-RFE) and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms. The predictive performance of random forest (RF), GDBT, linear regression (LR), and XGBoost models was evaluated using the area under the receiver operating characteristic curve (AUROC), precision–recall curve (AUPRC), accuracy, F1-score, precision, recall, sensitivity, and specificity. Feature importance was calculated, and the SHapley Additive exPlanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) methods were employed to explain the top-performing model.

          Results

          A total of 84 (39.1%) patients developed cerebral edema changes. In the validation cohort, GDBT outperformed LR and RF, achieving an AUC of 0.654 (95% CI: 0.611–0.699) compared to LR of 0.578 (95% CI, 0.535–0.623, DeLong: p = 0.197) and RF of 0.624 (95% CI, 0.588–0.687, DeLong: p = 0.236). XGBoost also demonstrated similar performance with an AUC of 0.660 (95% CI, 0.611–0.711, DeLong: p = 0.963). However, in the training set, GDBT still outperformed XGBoost, with an AUC of 0.603 ± 0.100 compared to XGBoost of 0.575 ± 0.096. SHAP analysis revealed that serum sodium, HDL, subarachnoid hemorrhage volume, sex, and left basal ganglia hemorrhage volume were the top five most important features for predicting cerebral edema changes in the GDBT model.

          Conclusion

          The GDBT model demonstrated the best performance in predicting 72-h changes in cerebral edema. It has the potential to assist clinicians in identifying high-risk patients and guiding clinical decision-making.

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          Big data and machine learning algorithms for health-care delivery

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            Accessing Artificial Intelligence for Clinical Decision-Making

            Advancements in computing and data from the near universal acceptance and implementation of electronic health records has been formative for the growth of personalized, automated, and immediate patient care models that were not previously possible. Artificial intelligence (AI) and its subfields of machine learning, reinforcement learning, and deep learning are well-suited to deal with such data. The authors in this paper review current applications of AI in clinical medicine and discuss the most likely future contributions that AI will provide to the healthcare industry. For instance, in response to the need to risk stratify patients, appropriately cultivated and curated data can assist decision-makers in stratifying preoperative patients into risk categories, as well as categorizing the severity of ailments and health for non-operative patients admitted to hospitals. Previous overt, traditional vital signs and laboratory values that are used to signal alarms for an acutely decompensating patient may be replaced by continuously monitoring and updating AI tools that can pick up early imperceptible patterns predicting subtle health deterioration. Furthermore, AI may help overcome challenges with multiple outcome optimization limitations or sequential decision-making protocols that limit individualized patient care. Despite these tremendously helpful advancements, the data sets that AI models train on and develop have the potential for misapplication and thereby create concerns for application bias. Subsequently, the mechanisms governing this disruptive innovation must be understood by clinical decision-makers to prevent unnecessary harm. This need will force physicians to change their educational infrastructure to facilitate understanding AI platforms, modeling, and limitations to best acclimate practice in the age of AI. By performing a thorough narrative review, this paper examines these specific AI applications, limitations, and requisites while reviewing a few examples of major data sets that are being cultivated and curated in the US.
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              Involvement of Machine Learning Tools in Healthcare Decision Making

              In the present day, there are many diseases which need to be identified at their early stages to start relevant treatments. If not, they could be uncurable and deadly. Due to this reason, there is a need of analysing complex medical data, medical reports, and medical images at a lesser time but with greater accuracy. There are even some instances where certain abnormalities cannot be directly recognized by humans. In healthcare for computational decision making, machine learning approaches are being used in these types of situations where a crucial data analysis needs to be performed on medical data to reveal hidden relationships or abnormalities which are not visible to humans. Implementing algorithms to perform such tasks itself is difficult, but what makes it even more challenging is to increase the accuracy of the algorithm while decreasing the required time for the algorithm to execute. In the early days, processing of large amount of medical data was an important task which resulted in machine learning being adapted in the biological domain. Since this happened, the biology and biomedical fields have been reaching higher levels by exploring more knowledge and identifying relationships which were never observed before. Reaching to its peak now the concern is being diverted towards treating patients not only based on the type of disease but also their genetics, which is known as precision medicine. Modifications in machine learning algorithms are being performed and tested daily to improve the performance of the algorithms in analysing and presenting more accurate information. In the healthcare field, starting from information extraction from medical documents until the prediction or diagnosis of a disease, machine learning has been involved. Medical imaging is a section that was greatly improved with the integration of machine learning algorithms to the field of computational biology. Nowadays, many disease diagnoses are being performed by medical image processing using machine learning algorithms. In addition, patient care, resource allocation, and research on treatments for various diseases are also being performed using machine learning-based computational decision making. Throughout this paper, various machine learning algorithms and approaches that are being used for decision making in the healthcare sector will be discussed along with the involvement of machine learning in healthcare applications in the current context. With the explored knowledge, it was evident that neural network-based deep learning methods have performed extremely well in the field of computational biology with the support of the high processing power of modern sophisticated computers and are being extensively applied because of their high predicting accuracy and reliability. When giving concern towards the big picture by combining the observations, it is noticeable that computational biology and biomedicine-based decision making in healthcare have now become dependent on machine learning algorithms, and thus they cannot be separated from the field of artificial intelligence.
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                Author and article information

                Contributors
                Role: Role: Role: Role:
                Role: Role:
                URI : https://loop.frontiersin.org/people/1947882/overviewRole: Role:
                URI : https://loop.frontiersin.org/people/2765296/overviewRole: Role:
                Role: Role:
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                URI : https://loop.frontiersin.org/people/2719301/overviewRole: Role: Role:
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                03 October 2024
                2024
                : 15
                : 1419608
                Affiliations
                [1] 1The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital , Quzhou, China
                [2] 2Postgraduate Training Base Alliance of Wenzhou Medical University , Wenzhou, China
                [3] 3Wenzhou Institute, University of Chinese Academy of Sciences , Wenzhou, China
                Author notes

                Edited by: Alejandro Rabinstein, Mayo Clinic, United States

                Reviewed by: Ping Hu, Second Affiliated Hospital of Nanchang University, China

                Muhannad Seyam, University of Vermont, United States

                *Correspondence: Xinjiang Yan, 1582344125@ 123456qq.com
                Article
                10.3389/fneur.2024.1419608
                11484451
                39421568
                3e00c549-e512-4e66-af6d-119c05c6afd7
                Copyright © 2024 Xu, Yuan, Yu, Li, Dong, Mao, Zhan and Yan.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 10 June 2024
                : 18 September 2024
                Page count
                Figures: 7, Tables: 4, Equations: 0, References: 36, Pages: 12, Words: 6504
                Funding
                The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by Science and Technology Program of QuZhou, China (grant no.2021Y003).
                Categories
                Neurology
                Original Research
                Custom metadata
                Neurocritical and Neurohospitalist Care

                Neurology
                sich,cerebral edema,random forest,gdbt,xgboost
                Neurology
                sich, cerebral edema, random forest, gdbt, xgboost

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