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Classification of Different Degrees of Disability Following Intracerebral Hemorrhage: A Decision Tree Analysis from
Thanh G Phan1, Jian Chen2, Richard Beare2
1Neurosciences, Monash Health , Melbourne, VIC , Australia.
Insights
A new trichotomy method accurately classifies disability after intracerebral hemorrhage (ICH), distinguishing mild, moderate, and severe outcomes. This approach offers a more nuanced prognostication tool for clinicians and researchers compared to traditional binary methods.
Area of Science:
- Neurology
- Neurosurgery
- Clinical Epidemiology
Background:
- Intracerebral hemorrhage (ICH) prognostication often groups mild and moderate disabilities, limiting precise outcome prediction.
- Existing methods lack granularity in classifying a spectrum of post-ICH functional outcomes.
Purpose of the Study:
- To develop and validate a novel classification approach for a range of disabilities following ICH.
- To improve the precision of prognostication for patients with intracerebral hemorrhage.
Main Methods:
- Utilized the Virtual International Stroke Trial Archive collaboration database for patients with ICH.
- Employed binary and trichotomy decision tree methodologies to partition disability into mild, moderate, and severe categories based on modified Rankin Scale (mRS) scores.
- Validated the decision tree models using area under the receiver operating characteristic curve (AUC) on randomly divided training and validation datasets.
Main Results:
- Identified 957 patients with ICH; mean age 65.9 years, 63.7% male, mean ICH volume 22.6 ml.
- Binary decision trees identified predictors for mild vs. moderate-to-severe disability (AUC 0.79) and severe disability (AUC 0.80) using ICH volume, age, glucose, systolic blood pressure, and Glasgow Coma Scale.
- A trichotomy decision tree effectively separated mild, moderate, and severe disability groups using ICH volume, age, and serum glucose, achieving an AUC of 0.79.
Conclusions:
- Both binary and trichotomy decision tree methods demonstrated comparable accuracy in discriminating ICH disability outcomes.
- The trichotomy method offers the advantage of simultaneously classifying three distinct disability levels (mild, moderate, severe).
- The trichotomy approach provides a valuable tool for clinicians and trialists in refining disability classification after ICH.
Background And Purpose:
Prognostication following intracerebral hemorrhage (ICH) has focused on poor outcome at the expense of lumping together mild and moderate disability. We aimed to develop a novel approach at classifying a range of disability following ICH.
Methods:
The Virtual International Stroke Trial Archive collaboration database was searched for patients with ICH and known volume of ICH on baseline CT scans. Disability was partitioned into mild [modified Rankin Scale (mRS) at 90 days of 0-2], moderate (mRS = 3-4), and severe disabilities (mRS = 5-6). We used binary and trichotomy decision tree methodology. The data were randomly divided into training (2/3 of data) and validation (1/3 data) datasets. The area under the receiver operating characteristic curve (AUC) was used to calculate the accuracy of the decision tree model.
Results:
We identified 957 patients, age 65.9 ± 12.3 years, 63.7% males, and ICH volume 22.6 ± 22.1 ml. The binary tree showed that lower ICH volume (<13.7 ml), age (<66.5 years), serum glucose (<8.95 mmol/l), and systolic blood pressure (<170 mm Hg) discriminate between mild versus moderate-to-severe disabilities with AUC of 0.79 (95% CI 0.73-0.85). Large ICH volume (>27.9 ml), older age (>69.5 years), and low Glasgow Coma Scale (<15) classify severe disability with AUC of 0.80 (95% CI 0.75-0.86). The trichotomy tree showed that ICH volume, age, and serum glucose can separate mild, moderate, and severe disability groups with AUC 0.79 (95% CI 0.71-0.87).
Conclusion:
Both the binary and trichotomy methods provide equivalent discrimination of disability outcome after ICH. The trichotomy method can classify three categories at once, whereas this action was not possible with the binary method. The trichotomy method may be of use to clinicians and trialists for classifying a range of disability in ICH.
