title: Application of neural networks to the classification of giant cell arteritis.
abstract: OBJECTIVE
  Neural networks are a group of computer-based pattern recognition methods that have recently been applied to clinical diagnosis and classification. In this study, we applied one type of neural network, the backpropagation network, to the diagnostic classification of giant cell arteritis (GCA).
  
  
  METHODS
  The analysis was performed on the 807 cases in the vasculitis database of the American College of Rheumatology. Classification was based on the 8 clinical criteria previously used for classification of this data set: 1) age > or = 50 years, 2) new localized headache, 3) temporal artery tenderness or decrease in temporal artery pulse, 4) polymyalgia rheumatica, 5) abnormal result on artery biopsy, 6) erythrocyte sedimentation rate > or = 50 mm/hour, 7) scalp tenderness or nodules, and 8) claudication of the jaw, of the tongue, or on swallowing. To avoid overtraining, network training was terminated when the generalization error reached a minimum. True cross-validation classification rates were obtained.
  
  
  RESULTS
  Neural networks correctly classified 94.4% of the GCA cases (n = 214) and 91.9% of the other vasculitis cases (n = 593). In comparison, classification trees correctly classified 91.6% of the GCA cases and 93.4% of the other vasculitis cases. Neural nets and classification trees were compared by receiver operating characteristic (ROC) analysis. The ROC curves for the two methods crossed, indicating that the better classification method depended on the choice of decision threshold. At a decision threshold that gave equal costs to percentage increases in false-positive and false-negative results, the methods were not significantly different in their performance (P = 0.45).
  
  
  CONCLUSIONS
  Neural networks are a potentially useful method for developing diagnostic classification rules from clinical data.
authors.affiliation: University of Washington, Department of Laboratory Medicine, Seattle 98195.
authors.forename: M L
authors.initials: ML
authors.lastname: Astion
authors.forename: M H
authors.initials: MH
authors.lastname: Wener
authors.forename: R G
authors.initials: RG
authors.lastname: Thomas
authors.forename: G G
authors.initials: GG
authors.lastname: Hunder
authors.forename: D A
authors.initials: DA
authors.lastname: Bloch
mesh_terms: D003936:Diagnosis, Computer-Assisted; D013700:Giant Cell Arteritis / Q000145:classification*; D006801:Humans; D008875:Middle Aged; D016571:Neural Networks, Computer; D012372:ROC Curve; D012680:Sensitivity and Specificity