Comparison of logistic regression and neural networks to predict rehospitalization in patients with stroke

• Published in: Journal of clinical epidemiology Vol. 54; no. 11; pp. 1159 - 1165
• Main Authors: Ottenbacher, Kenneth J, Smith, Pam M, Illig, Sandra B, Linn, Richard T, Fiedler, Roger C, Granger, Carl V
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2001; Elsevier
• Subjects: Aged; Biological and medical sciences; Epidemiology; Female; General aspects; Health Status Indicators; Humans; Logistic Models; Logistic regression; Male; Medical sciences; Methodology; Middle Aged; Neural networks; Neural Networks (Computer); Neurology; Patient Readmission - statistics & numerical data; Probability; Public health. Hygiene; Public health. Hygiene-occupational medicine; ROC Curve; Sensitivity and Specificity; Stroke; Stroke Rehabilitation; United States - epidemiology; Vascular diseases and vascular malformations of the nervous system; Logistic regression; Neural networks; Stroke; Human; Nervous system diseases; Methodology; Prediction; Cardiovascular disease; Epidemiology; Cerebral disorder; Vascular disease; Rehospitalization; Central nervous system disease; Cerebrovascular disease; Comparative study; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/S0895-4356(01)00395-X

Context: Rehospitalization following inpatient medical rehabilitation has important health and economic implications for patients who have experienced a stroke. Objective: Compare logistic regression and neural networks in predicting rehospitalization at 3–6-month follow-up for patients with stroke discharged from medical rehabilitation. Design: The study was retrospective using information from a national database representative of medical rehabilitation patients across the US. Setting: Information submitted to the Uniform Data System for Medical Rehabilitation from 1997 and 1998 by 167 hospital and rehabilitation facilities from 40 states was examined. Participants: 9584 patient records were included in the sample. The mean age was 70.74 years (SD = 12.87). The sample included 51.6% females and was 77.6% non-Hispanic White with an average length of stay of 21.47 days (SD = 15.47). Main Outcome Measures: Hospital readmission from 80 to 180 days following discharge. Results: Statistically significant variables (P < .05) in the logistic model included sphincter control, self-care ability, age, marital status, ethnicity and length of stay. Area under the ROC curves were 0.68 and 0.74 for logistic regression and neural network analysis, respectively. The Hosmer-Lemeshow goodness-of-fit chi-square was 11.32 ( df = 8, P = 0.22) for neural network analysis and 16.33 ( df = 8, P = 0.11) for logistic regression. Calibration curves indicated a slightly better fit for the neural network model. Conclusion: There was no statistically significant or practical advantage in predicting hospital readmission using neural network analysis in comparison to logistic regression for persons who experienced a stroke and received medical rehabilitation during the period of the study.