Developing and externally validating a machine learning risk prediction model for 30-day mortality after stroke using national stroke registers in the UK and Sweden.

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Wang, WenjuanDepartment of Population Health Sciences, King's College London, London, UK (author)

Developing and externally validating a machine learning risk prediction model for 30-day mortality after stroke using national stroke registers in the UK and Sweden.

Article/chapterEnglish2023

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BMJ Publishing Group Ltd,2023
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LIBRIS-ID:oai:DiVA.org:umu-216802
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-216802URI
https://doi.org/10.1136/bmjopen-2022-069811DOI

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Language:English
Summary in:English

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OBJECTIVES: We aimed to develop and externally validate a generalisable risk prediction model for 30-day stroke mortality suitable for supporting quality improvement analytics in stroke care using large nationwide stroke registers in the UK and Sweden.DESIGN: Registry-based cohort study.SETTING: Stroke registries including the Sentinel Stroke National Audit Programme (SSNAP) in England, Wales and Northern Ireland (2013-2019) and the national Swedish stroke register (Riksstroke 2015-2020).PARTICIPANTS AND METHODS: Data from SSNAP were used for developing and temporally validating the model, and data from Riksstroke were used for external validation. Models were developed with the variables available in both registries using logistic regression (LR), LR with elastic net and interaction terms and eXtreme Gradient Boosting (XGBoost). Performances were evaluated with discrimination, calibration and decision curves.OUTCOME MEASURES: The primary outcome was all-cause 30-day in-hospital mortality after stroke.RESULTS: In total, 488 497 patients who had a stroke with 12.4% 30-day in-hospital mortality were used for developing and temporally validating the model in the UK. A total of 128 360 patients who had a stroke with 10.8% 30-day in-hospital mortality and 13.1% all mortality were used for external validation in Sweden. In the SSNAP temporal validation set, the final XGBoost model achieved the highest area under the receiver operating characteristic curve (AUC) (0.852 (95% CI 0.848 to 0.855)) and was well calibrated. The performances on the external validation in Riksstroke were as good and achieved AUC at 0.861 (95% CI 0.858 to 0.865) for in-hospital mortality. For Riksstroke, the models slightly overestimated the risk for in-hospital mortality, while they were better calibrated at the risk for all mortality.CONCLUSION: The risk prediction model was accurate and externally validated using high quality registry data. This is potentially suitable to be deployed as part of quality improvement analytics in stroke care to enable the fair comparison of stroke mortality outcomes across hospitals and health systems across countries.

Subject headings and genre

NATURVETENSKAP Matematik Sannolikhetsteori och statistik hsv//swe
NATURAL SCIENCES Mathematics Probability Theory and Statistics hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Neurologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Neurology hsv//eng
neurology
quality in health care
statistics & research methods
stroke
Statistics
statistik
Neurology
neurologi

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Otieno, Josline A.Umeå universitet,Statistik(Swepub:umu)joot5519 (author)
Eriksson, Marie,ProfessorUmeå universitet,Statistik(Swepub:umu)maer0004 (author)
Wolfe, Charles D.Department of Population Health Sciences, King's College London, London, UK (author)
Curcin, VasaDepartment of Population Health Sciences, King's College London, London, UK (author)
Bray, Benjamin DDepartment of Population Health Sciences, King's College London, London, UK (author)
Department of Population Health Sciences, King's College London, London, UKStatistik (creator_code:org_t)

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In:BMJ Open: BMJ Publishing Group Ltd13:112044-6055

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