What is machine learning

Traditional software Machine learning

• Computer code • Learning model
• Rules-based systems • Learns from examples
• No flexibility • Inputs (Features)
• Outputs (Labels)
Machine vs Human

Machine learning Human learning

• Required more example to make • Small amounts of data
general associations • Common sense
• Can learn from massive amount
of data
• No common sense
Supervised machine learning
Application of Machine learning
• Prognosis • Workflow
• Parameter > Clinical outcomes
• Predictive typing
• Diagnosis • Automatic summarization
• Suggest test • Surgery assistant
• Raise awareness of diagnosis
• Treatment
• Recommend treatment
• Compare treatment with model
• Treatment based on expert/new clinical guideline/update paper
• Identify pt. who may benefit from new drug/therapy under study
Key challenges
• Assembling representative data set
• Ideal
• Train model with data mostly resemble exact format expected during use
• Data from trial
• Need to have same specifications to be optimal
• Limitations
• Model not generalized to particular scenario
• Overreliance > bias, decrease vigilance for errors
• Need for prospective, real-world clinical evaluation
• Retrospective study
• Spinal epidural abscess age > 18 years Dx. By CT/MRI
• Tx: Conservative (Abx +/- IVR drainage)
• N: 472/1053 Tx conservatively
Outcomes and variables
• Primary outcomes: Failure of conservative Tx
• Neurologic deterioration
• Worsened back/radicular pain
• Persistent symptoms > Change in Mx
• Progression based on imaging > Change in Mx
• Variables
• Demographic, Signs and symptoms, duration of symptoms
• Lab, Microbiology, Radiographic characteristic
• Concurrent spinal/nonspinal infections
Machine learning methods
• Population: 80:20 split
• Derivation (80%)
• Use for machine training
• Validation (20%)
• Use for evaluating
• 5 Machine learning methods
• Elastic-net penalized logistic regression
• Stochastic gradient boosting
• Random forest
• Support vector machine
• Neural network
Results
• Variables include in final algorithm
• Motor deficit
• DM
• Ventral component of abscess related to thecal sac
• Hx of compression/pathologic fracture
• Sensory dysfunction
• Active malignancy
• 3 or more spinal level
• Best model: Elastic-net penalized logistic regression
Discussion
• Conservative in SEA
• Normal neurological exam
• Extensive panspinal infection
• Complete paralysis for > 72 hr
• Poor surgical candidacy
• Refusal to Sx
• Previous risk for failure
• DM, Leukocytosis > 12500, H/C positive, CRP > 115.7
• Age > 65, DM, MRSA, Pretreatment motor deficit
• Active malignancy, Fracture at affected level
• Negative factor: Abscess at dorsal related to thecal sac
https://sorg-apps.shinyapps.io/sean
onop/