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GPT-4 as a Clinical Decision Support Tool in Ischemic Stroke Management: Evaluation Study
Amit Haim Shmilovitch1, Mark Katson1, Michal Cohen-Shelly2
1Department of Neurology, Rambam Medical Center, Haifa, Israel.
JMIR AI
|March 7, 2025
Summary
GPT-4 shows strong potential as a clinical decision-support tool for acute ischemic stroke management, aligning well with expert opinions and real-world outcomes. Human oversight remains crucial due to its tendency for more aggressive treatment recommendations.
Area of Science:
- Neurology
- Artificial Intelligence
- Medical Informatics
Background:
- Cerebrovascular diseases are a leading cause of death and disability globally.
- Artificial intelligence (AI) offers transformative potential in critical healthcare decisions, including ischemic stroke management.
Purpose of the Study:
- To evaluate GPT-4's effectiveness in clinical support for emergency neurologists managing acute ischemic stroke.
- To compare GPT-4's recommendations against expert opinions and real-world patient outcomes.
Main Methods:
- Retrospective review of 100 acute stroke patient cases.
- GPT-4 provided treatment recommendations, mortality predictions, and reasoning.
- Comparison of GPT-4 recommendations with stroke specialist opinions and actual treatment decisions.
Main Results:
- GPT-4 demonstrated strong agreement with expert opinion (AUC 0.85) and real-world decisions (AUC 0.80).
- Near-perfect agreement for endovascular thrombectomy recommendations (AUC 0.94) and strong for tissue plasminogen activator (AUC 0.77).
- GPT-4 outperformed other AI models in mortality prediction (AUC 0.89).
Conclusions:
- GPT-4 shows promise as a clinical decision-support tool for acute stroke, offering explainable recommendations.
- Its potential for more aggressive treatment suggestions underscores the necessity of human clinical oversight.
- Future research should focus on prospective validation and safe integration into clinical workflows.
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