Automated Evaluation of Urodynamic Examinations Through Local Linear Models: Validation on Spinal Cord Injury Individuals

Abstract

Objective: Investigating consistent methods and metrics for classifying Detrusor Overactivity (DO) events and developing an automated robust method for clinical measurements calculation from cystometry data in persons with spinal cord injury (SCI).Methods and procedures: A two-stage method for was proposed to detect DO events. In the first stage, DO peaks were detected using local linear models combined with thresholding criteria derived from clinical definitions and known artifacts. In the second stage, a segmentation method was proposed to detect the start and end time points of each DO event, marking the DO activity periods. As a result, complete clinical measurements, including bladder compliance, can be estimated automatically. The method was developed and tested on 77 anonymized urodynamic samples from SCI individuals (40 DO-positive, 37 DO-negative) with 158 annotated DO events.Results: On test data, in terms of the patient-level diagnosis of DO, the proposed method achieved an accuracy of 100%. Individual DO event detection achieved an average precision of 0.94 and recall of 0.72. Detrusor activity period identification showed a precision of 0.86 and a recall of 0.88. The task of automated bladder compliance estimation showed that the point-value-based method yields a lower median absolute error (MAE) compared to the proposed line-fitting-based method, with a MAE of 5.20 and 7.14 ml/cmH2O, respectively. Finally, for classifying bladder function into normal, low and severely low compliance, the proposed method had an accuracy of 88%.Conclusion: Our proposed local model fitting with thresholding based on clinical knowledge, achieved accurate automated results for cytometry data, which will enable objective assessment of routinely performed examinations.Clinical and Translational Impact Statement—This work proposes a fully automated detrusor overactivity diagnosis and feature extraction method. Empowering medical teams to consistently assess urodynamic studies while aiding disease characterization and enhancing clinical decision-making for SCI patients. Furthermore, it provides a mathematically defined method for extending the pipeline to other populations and standardizing clinical assessments.Category: Clinical Engineering, Medical Devices and Systems.