Prediction of Unsuccessful Endometrial Ablation: Random Forest vs Logistic Regression

Abstract Background: Five percent of premenopausal women experience abnormal uterine bleeding. Endometrial ablation (EA) is one of the treatment options for this common problem. However, this technique shows a decrease in patient satisfaction and treatment efficacy on the long term Study objective: To develop a prediction model to predict surgical re-intervention (for example re-ablation or hysterectomy) within two years after EA by using Machine Learning (ML). The performance of the developed prediction model was compared with a previously published multivariate logistic regression model (LR). Design: This retrospective cohort study, with a minimal follow up time of two years, included 446 pre-menopausal women (18+) that underwent an EA for complaints of heavy menstrual bleeding. The performance of the ML- and the LR model was compared using the area under the Receiving Operating Characteristic (ROC) curve. Results: We found out that the ML model (AUC of 0.65 (95% CI 0.56-0.74)) is not superior compared to the LR model (AUC of 0.71 (95% CI 0.64-0.78)) in predicting the outcome of surgical re-intervention within two years after EA. Conclusion: Although Machine Learning techniques are gaining popularity in development of clinical prediction tools, this study shows that ML is not necessarily superior to the traditional statistical LR techniques. The performance of a prediction model is influenced by the sample size, the number of features of a dataset, hyperparameter tuning and the linearity of associations. Both techniques should be considered when developing a clinical prediction model.