Predicting 30-Day Readmission for Stroke Using Machine Learning Algorithms: A Prospective Cohort Study

Yu-Ching Chen; Jo-Hsuan Chung; Yu-Jo Yeh; Shi-Jer Lou; Hsiu-Fen Lin; Ching-Huang Lin; Hong-Hsi Hsien; Kuo-Wei Hung; Shu-Chuan Jennifer Yeh; Hon-Yi Shi

doi:10.3389/fneur.2022.875491

Predicting 30-Day Readmission for Stroke Using Machine Learning Algorithms: A Prospective Cohort Study

Front Neurol. 2022 Jul 4:13:875491. doi: 10.3389/fneur.2022.875491. eCollection 2022.

Authors

Yu-Ching Chen^{1

2}, Jo-Hsuan Chung¹, Yu-Jo Yeh¹, Shi-Jer Lou^{1

3}, Hsiu-Fen Lin^{4

5}, Ching-Huang Lin⁶, Hong-Hsi Hsien⁷, Kuo-Wei Hung⁸, Shu-Chuan Jennifer Yeh^{1

9}, Hon-Yi Shi^{1

3

9

10

11}

Affiliations

¹ Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
³ Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung, Taiwan.
⁴ Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁵ Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Division of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁷ Department of Internal Medicine, St. Joseph Hospital, Kaohsiung, Taiwan.
⁸ Division of Neurology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.
⁹ Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan.
¹⁰ Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹¹ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.

Abstract

Background: Machine learning algorithms for predicting 30-day stroke readmission are rarely discussed. The aims of this study were to identify significant predictors of 30-day readmission after stroke and to compare prediction accuracy and area under the receiver operating characteristic (AUROC) curve in five models: artificial neural network (ANN), K nearest neighbor (KNN), random forest (RF), support vector machine (SVM), naive Bayes classifier (NBC), and Cox regression (COX) models.

Methods: The subjects of this prospective cohort study were 1,476 patients with a history of admission for stroke to one of six hospitals between March, 2014, and September, 2019. A training dataset (n = 1,033) was used for model development, and a testing dataset (n = 443) was used for internal validation. Another 167 patients with stroke recruited from October, to December, 2019, were enrolled in the dataset for external validation. A feature importance analysis was also performed to identify the significance of the selected input variables.

Results: For predicting 30-day readmission after stroke, the ANN model had significantly (P < 0.001) higher performance indices compared to the other models. According to the ANN model results, the best predictor of 30-day readmission was PAC followed by nasogastric tube insertion and stroke type (P < 0.05). Using a machine learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients.

Conclusion: Using a machine-learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients. For stroke patients who are candidates for PAC rehabilitation, these predictors have practical applications in educating patients in the expected course of recovery and health outcomes.

Keywords: 30-day readmission; artificial neural network; feature importance analysis; post-acute care; stroke.