Predicting Spinal Cord Injury Prognosis Using Machine Learning: Systematic Review and Meta-Analysis.

Background: Spinal cord injury (SCI) is complicated and varied conditions that receive a lot of attention. However, the prognosis of patients with SCI is increasingly being predicted using machine learning (ML) techniques. Objective: This study aims to evaluate the efficacy and caliber of ML models in forecasting the consequences of SCI. Methods: Literature searches were conducted in PubMed, Web of Science, Embase, PROSPERO, Scopus, Cochrane Library, China National Knowledge Infrastructure, China Biomedical Literature Service System, and Wanfang databases. Meta-analysis of the area under the receiver operating characteristic curve of ML models was performed to comprehensively evaluate their performance. Results: A total of 1254 articles were retrieved, and 13 eligible studies were included. Predictive outcomes included spinal cord function prognosis, postoperative complications, independent living ability, and walking ability. For spinal cord function prognosis, the area under the curve (AUC) of the random forest algorithm was 0.832, the AUC of the logistic regression algorithm was 0.813 (95% CI 0.805-0.883), the AUC of the decision tree algorithm was 0.747 (95% CI 0.677-0.802), and the AUC of the XGBoost (extreme gradient boosting) algorithm was 0.867. For postoperative complications, the AUC of the random forest algorithm was 0.627 (95% CI 0.441-0.812), the AUC of the logistic regression algorithm was 0.747 (95% CI 0.597-0.896), and the AUC of the decision tree algorithm was 0.688. For independent living ability, the AUC of the classification and regression tree model was 0.813. For walking ability, the model based on the vector machine algorithm was the most effective, with an AUC of 0.780. Conclusions: The ML models predict SCI outcomes with relative accuracy, particularly in spinal cord function prognosis. They are expected to become important tools for clinicians in assessing the prognosis of patients with SCI, with the XGBoost algorithm showing the best performance. Prediction models should continue to advance as large data are used and ML algorithms develop.