Machine learning predictive models in neurosurgery: an appraisal based on the TRIPOD guidelines. Systematic review.

Objective: In recent years, machine learning models for clinical prediction have become increasingly prevalent in the neurosurgical literature. However, little is known about the quality of these models, and their translation to clinical care has been limited. The aim of this systematic review was to empirically determine the adherence of machine learning models in neurosurgery with standard reporting guidelines specific to clinical prediction models.

Methods: Studies describing the development or validation of machine learning predictive models published between January 1, 2020, and January 10, 2023, across five neurosurgery journals (Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, Neurosurgery, and World Neurosurgery) were included. Studies where the TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines were not applicable, radiomic studies, and natural language processing studies were excluded.

Results: Forty-seven studies featuring a machine learning-based predictive model in neurosurgery were included. The majority (53%) of studies were single-center studies, and only 15% of studies externally validated the model in an independent cohort of patients. The median compliance across all 47 studies was 82.1% (IQR 75.9%-85.7%). Giving details of treatment (n = 17 [36%]), including the number of patients with missing data (n = 11 [23%]), and explaining the use of the prediction model (n = 23 [49%]) were identified as the TRIPOD criteria with the lowest rates of compliance.

Conclusions: Improved adherence to TRIPOD guidelines will increase transparency in neurosurgical machine learning predictive models and streamline their translation into clinical care.