Mateen, Bilal Akhter, Bussas, Matthias, Doogan, Catherine, Waller, Denise, Saverino, Alessia, Király, Franz J. and Playford, E. Diane (2018) The Trail Making test : a study of its ability to predict falls in the acute neurological in-patient population. Clinical Rehabilitation, 32 (10). pp. 1396-1405. doi:10.1177/0269215518771127 ISSN 0269-2155.

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Abstract

Objective:
To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls.

Design:
Prospective cohort study.

Setting:
Tertiary neurological and neurosurgical center.

Subjects:
In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care.

Main Measures:
Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function).

Results:
The principal outcome was a fall during the in-patient stay (n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the best modeling strategy when utilizing just the Trail Making Test data (Wilcoxon signed-rank P < 0.001) with 68% (± 7.7) sensitivity, and 90% (± 2.3) specificity.

Conclusion:
This study identifies a simple yet powerful machine learning (Random Forest) based predictive model for an in-patient neurological population, utilizing a single neuropsychological test of cognitive function, the Trail Making test.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Falls (Accidents) -- Risk factors, Cognition disorders, Nervous system -- Diseases, Executive functions (Neuropsychology), Attention, Decision support systems
Journal or Publication Title:	Clinical Rehabilitation
Publisher:	Sage Publications Ltd.
ISSN:	0269-2155
Official Date:	1 October 2018
Dates:	Date Event 1 October 2018 Published 29 May 2018 Available 25 March 2018 Accepted 9 April 2017 Submitted 5 July 2016 Modified
Volume:	32
Number:	10
Page Range:	pp. 1396-1405
DOI:	10.1177/0269215518771127
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	Mateen, Bilal Akhter, Bussas, Matthias, Doogan, Catherine, Waller, Denise, Saverino, Alessia, Király, Franz J. and Playford, E. Diane (2018) The Trail Making test: a study of its ability to predict falls in the acute neurological in-patient population. Clinical Rehabilitation, 32 (10). pp. 1396-1405. doi:10.1177/0269215518771127. Copyright © 2018 The Authors. Reprinted by permission of SAGE Publications. doi:10.1177/0269215518771127.
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	8 October 2018
Date of first compliant Open Access:	9 October 2018
Open Access Version:	ArXiv

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