Multilayer perceptron-based prediction of stroke mimics in prehospital triage

Abstract

The identification of stroke mimics (SMs) in patients with stroke could lead to delayed diagnosis and waste of medical resources. Multilayer perceptron (MLP) was proved to be an accurate tool for clinical applications. However, MLP haven't been applied in patients with suspected stroke onset within 24 h. Here, we aimed to develop a MLP model to predict SM in patients. We retrospectively reviewed the data of patients with a prehospital diagnosis of suspected stroke between July 2017 and June 2021. SMs were confirmed during hospitalization. We included demographic information, clinical manifestations, medical history, and systolic and diastolic pressure on admission. First, the cohort was randomly divided into a training set (70%) and an external testing set (30%). Then, the least absolute shrinkage and selection operator (LASSO) method was used in feature selection and an MLP model was trained based on the selected items. Then, we evaluated the performance of the model using the ten-fold cross validation method. Finally, we used the external testing set to compare the MLP model with FABS scoring system (FABS) and TeleStroke Mimic Score (TM-Score) using a receiver operator characteristic (ROC) curve. In total, 402 patients were included. Of these, 82 (20.5%) were classified as SMs. During the ten-fold cross validation, the mean area under the ROC curve (AUC) of 10 training sets and 10 validation sets were 0.92 and 0.87, respectively. In the external testing set, the AUC of the MLP model was significantly higher than that of the FABS (0.855 vs. 0.715, P = 0.038) and TM-Score (0.855 vs. 0.646, P = 0.006). The MLP model had significantly better performance in predicting SMs than FABS and TM-Score.