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Neural Network Assessment of Perioperative Cardiac Risk in Vascular Surgery Patients

Gilbert J. L'Italien, PhD

Sumita Paul, MD, MPH

Robert C. Hendel, MD

Jeffrey A. Leppo, MD

Lee A. Fleisher, MD

Mylan C. Cohen, MD, MPH

Kim A. Eagle, MD

Robert P. Giugliano, MD

Neural networks were developed to predict perioperative cardiac complications with data from 567 vascular surgery patients. Neural network scores were based on cardiac risk factors and dipyridamole thallium results. These scores were converted into like lihood ratios that predicted cardiac risk. The prognostic accuracy of the neural networks was similar to that of logistic regression models (ROC areas 76.0% vs 75.8%), but their calibration was better. Logistic regression overestimated event rates in a group of high-risk patients (predicted event rate, 64%; observed rate 30%; n = 50, p < 0.001). On a validation set of 514 patients, the neural networks still had ROC similar areas to those of logistic regression (68.3% vs 67.5%), but logistic regression again overesti mated event rates for a group of high-risk patients. The calibration difference was reflected in the Hosmer-Lemeshow chi-square statistic (18.6 for the neural networks, 45.0 for logistic regression). The neural networks successfully estimated perioperative cardiac risk with better calibration than comparable logistic regression models. Key words. neural networks; logistic regression; likelihood ratio; Bayes' theorem; cardiac risk. (Med Decis Making 1998;18:70-75)

Medical Decision Making, Vol. 18, No. 1, 70-75 (1998)
DOI: 10.1177/0272989X9801800114


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