Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Machine Learning Algorithms Provide Greater Prediction of Response to Scs Than Lead Screening Trial: A Predictive AI-Based Multicenter Study

Version 1 : Received: 31 August 2021 / Approved: 1 September 2021 / Online: 1 September 2021 (12:05:18 CEST)

How to cite: Ounajim, A.; Billot, M.; Goudman, L.; Louis, P.; Slaoui, Y.; Roulaud, M.; Bouche, B.; Page, P.; Lorgeoux, B.; Baron, S.; Adjali, N.; Nivole, K.; Naiditch, N.; Wood, C.; Rigoard, R.; David, R.; Moens, M.; Rigoard, P. Machine Learning Algorithms Provide Greater Prediction of Response to Scs Than Lead Screening Trial: A Predictive AI-Based Multicenter Study. Preprints 2021, 2021090010 (doi: 10.20944/preprints202109.0010.v1). Ounajim, A.; Billot, M.; Goudman, L.; Louis, P.; Slaoui, Y.; Roulaud, M.; Bouche, B.; Page, P.; Lorgeoux, B.; Baron, S.; Adjali, N.; Nivole, K.; Naiditch, N.; Wood, C.; Rigoard, R.; David, R.; Moens, M.; Rigoard, P. Machine Learning Algorithms Provide Greater Prediction of Response to Scs Than Lead Screening Trial: A Predictive AI-Based Multicenter Study. Preprints 2021, 2021090010 (doi: 10.20944/preprints202109.0010.v1).

Abstract

Persistent Pain after Spinal Surgery can be successfully addressed by Spinal Cord Stimulation (SCS). International guidelines strongly recommend that a lead trial be performed before any permanent implantation. Recent clinical data highlight some major limitations of this approach. First, it appears that patient outcomes, WITH OR WITHOUT lead trial, are similar. In contrast, during trialing, infection rate drops drastically within time and can compromise the therapy. Using composite pain assessment experience and previous research, we hypothesized that ma-chine learning models could be robust screening tools and reliable predictors of long-term SCS efficacy. We developed several algorithms including logistic regression, Regularized Logistic Regression (RLR), naive Bayes classifier, artificial neural networks, random forest and gradient boosted trees to test this hypothesis and to perform internal and external validations, the objec-tive being to confront model predictions with lead trial results using a 1-year composite out-come from 103 patients. While almost all models have demonstrated superiority on lead trial-ing, the RLR model appears to represent the best compromise between complexity and inter-pretability in prediction of SCS efficacy. These results underscore the need to use AI based-predictive medicine, as a synergistic mathematical approach, aimed at helping implanters to optimize their clinical choices on daily practice.

Keywords

spinal cord stimulation; screening trial; infection; supervised learning; machine learning; predictive modeling; patient outcome

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