From Continuous Predictors to Clinical Thresholds: Early Evidence on Performance Trade-offs of Guideline-Based Categorisation for Ischaemic Stroke Outcome Prediction
arXiv:2608.05203v1 Announce Type: new Abstract: Machine learning models achieve strong predictive accuracy for 90-day outcome prediction in acute ischaemic stroke, yet clinical adoption is limited by the misalignment of model explanations with clinicians' reasoning. Motivated by a clinician user study calling for clinical guideline-aligned cut-offs, we ask whether continuous predictors can be replaced by clinically informed categorical encodings without sacrificing performance. On a multi-centre European registry stratified into three treatment cohorts, we compare standard and fully categorised gradient-boosted models, the latter using stroke guideline-aligned, treatment-specific thresholds. The fully categorised models are statistically indistinguishable from their continuous counterparts in two of the treatment cohorts, with a significant drop in predictive accuracy in one cohort. Global feature importance rankings remain consistent, suggesting that discretising continuous predictors into guideline-based categories preserves the core hierarchy of prognostic factors across all treatment groups. Guideline-based categorisation is thus a viable design choice for stroke-outcome models.
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[Submitted on 5 Aug 2026]
Title:From Continuous Predictors to Clinical Thresholds: Early Evidence on Performance Trade-offs of Guideline-Based Categorisation for Ischaemic Stroke Outcome Prediction
View a PDF of the paper titled From Continuous Predictors to Clinical Thresholds: Early Evidence on Performance Trade-offs of Guideline-Based Categorisation for Ischaemic Stroke Outcome Prediction, by Esra Zihni and 5 other authors
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Abstract:Machine learning models achieve strong predictive accuracy for 90-day outcome prediction in acute ischaemic stroke, yet clinical adoption is limited by the misalignment of model explanations with clinicians' reasoning. Motivated by a clinician user study calling for clinical guideline-aligned cut-offs, we ask whether continuous predictors can be replaced by clinically informed categorical encodings without sacrificing performance. On a multi-centre European registry stratified into three treatment cohorts, we compare standard and fully categorised gradient-boosted models, the latter using stroke guideline-aligned, treatment-specific thresholds. The fully categorised models are statistically indistinguishable from their continuous counterparts in two of the treatment cohorts, with a significant drop in predictive accuracy in one cohort. Global feature importance rankings remain consistent, suggesting that discretising continuous predictors into guideline-based categories preserves the core hierarchy of prognostic factors across all treatment groups. Guideline-based categorisation is thus a viable design choice for stroke-outcome models.
Comments: 9 pages, 2 figures
Subjects:
Artificial Intelligence (cs.AI); Machine Learning (cs.LG)
Cite as: arXiv:2608.05203 [cs.AI]
(or arXiv:2608.05203v1 [cs.AI] for this version)
https://doi.org/10.48550/arXiv.2608.05203
arXiv-issued DOI via DataCite
Submission history
From: Hendrik Knoche [view email] [v1] Wed, 5 Aug 2026 06:59:11 UTC (905 KB)
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