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Background: The use of machine learning is becoming increasingly popular in many disciplines, but there is still an implementation gap of machine learning models in clinical settings. Lack of trust in models is one of the issues that need to be addressed in an effort to close this gap. No models are perfect, and it is crucial to know in which use cases we can trust a model and for which cases it is less reliable., Methods: Four different algorithms are trained on the eICU Collaborative Research Database using similar features as the APACHE IV severity-of-disease scoring system to predict hospital mortality in the ICU. The training and testing procedure is repeated 100 times on the same dataset to investigate whether predictions for single patients change with small changes in the models. Features are then analysed separately to investigate potential differences between patients consistently classified correctly and incorrectly., Results: A total of 34 056 patients (58.4%) are classified as true negative, 6 527 patients (11.3%) as false positive, 3 984 patients (6.8%) as true positive, and 546 patients (0.9%) as false negatives. The remaining 13 108 patients (22.5%) are inconsistently classified across models and rounds. Histograms and distributions of feature values are compared visually to investigate differences between groups., Conclusions: It is impossible to distinguish the groups using single features alone. Considering a combination of features, the difference between the groups is clearer. Incorrectly classified patients have features more similar to patients with the same prediction rather than the same outcome., (© 2023. The Author(s).)

Background: Machine learning (ML) holds the promise of becoming an essential tool for utilising the increasing amount of clinical data available for analysis and clinical decision support. However, the lack of trust in the models has limited the acceptance of this technology in healthcare. This mistrust is often credited to the shortage of model explainability and interpretability, where the relationship between the input and output of the models is unclear. Improving trust requires the development of more transparent ML methods., Methods: In this paper, we use the publicly available eICU database to construct a number of ML models before examining their internal behaviour with SHapley Additive exPlanations (SHAP) values. Our four models predicted hospital mortality in ICU patients using a selection of the same features used to calculate the APACHE IV score and were based on random forest, logistic regression, naive Bayes, and adaptive boosting algorithms., Results: The results showed the models had similar discriminative abilities and mostly agreed on feature importance while calibration and impact of individual features differed considerably and did in multiple cases not correspond to common medical theory., Conclusions: We already know that ML models treat data differently depending on the underlying algorithm. Our comparative analysis visualises implications of these differences and their importance in a healthcare setting. SHAP value analysis is a promising method for incorporating explainability in model development and usage and might yield better and more trustworthy ML models in the future., (© 2022. The Author(s).)