Abstract
Aims
Clinical decision support systems (CDSS) can support clinicians in selecting appropriate treatments for patients. The objective of this study was to examine if triaging patients with LBP to the most optimal treatment can be improved by using a data-driven approach with the help of machine learning as base of such a CDSS.
Methods
A clinical database of the Groningen Spine Center containing patient-reported data from 1546 patients with LBP was used. From this dataset, a training dataset with 354 features was labeled on eight different treatments actually received by these patients. With this dataset, models were trained. A test dataset with 50 cases judged on treatments by 4 experts in LBP triage was used to test these models with data not used to train the models. Prediction accuracy and average area under curve (AUC) were used as performance measures for the models.
Results
The AUC values indicated small to medium learning effects showing that machine learning on patient-reported data, to model decision-making processes on treatments for LBP, may be possible. One of the best performing models was the Bayesian Network (BN) model; e.g. predicted surgery with accuracy 0.78 (95% C.I. 0.68– 0.87) and AUC 0.70.
Conclusion
Benefits to using BNs compared to other supervised machine learning techniques are that it is easy to exploit expert knowledge in BN models, meaning that advices generated by the model can be explained. The next step is to improve the BN accuracy so that it can actually be used in a CDSS.
No conflicts of interest
Sources of funding: This work is partly funded by a grant from the Netherlands Organization for Health Research and Development (ZonMw), grant 10-10400-98-009.
