Evaluating GPT-4 as a Clinical Decision Support Tool in Ischemic Stroke Management

Cerebrovascular diseases are the second most common cause of death worldwide and one of the major causes of disability burden. Advancements in artificial intelligence (AI) have the potential to revolutionize healthcare delivery, particularly in critical decision-making scenarios such as ischemic stroke management. This study evaluates the effectiveness of GPT-4 in providing clinical decision support for emergency room neurologists by comparing its recommendations with expert opinions and real-world treatment outcomes. A cohort of 100 consecutive patients with acute stroke symptoms was retrospectively reviewed. The data used for decision making included patients history, clinical evaluation, imaging studies results, and other relevant details. Each case was independently presented to GPT-4, which provided a scaled recommendation (1-7) regarding the appropriateness of treatment, the use of tissue plasminogen activator (tPA), and the need for endovascular thrombectomy (EVT). Additionally, GPT-4 estimated the 90-day mortality probability for each patient and elucidated its reasoning for each recommendation. The recommendations were then compared with those of a stroke specialist and actual treatment decision. The agreement of GPT-4s recommendations with the expert opinion yielded an Area Under the Curve (AUC) of 0.85 [95% CI: 0.77-0.93], and with real-world treatment decisions, an AUC of 0.80 [0.69-0.91]. In terms of mortality prediction, out of 13 patients who died within 90 days, GPT-4 accurately identified 10 within its top 25 high-risk predictions (AUC = 0.89 [95% CI: 0.8077-0.9739]; HR: 6.98 [95% CI: 2.88-16.9]), surpassing supervised machine-learning models. This study demonstrates the potential of GPT-4 as a viable clinical decision support tool in the management of ischemic stroke. Its ability to provide explainable recommendations without requiring structured data input aligns well with the routine workflows of treating physicians. Future studies should focus on prospective validations and exploring the integration of such AI tools into clinical practice.