# From Continuous Predictors to Clinical Thresholds: Early Evidence on Performance Trade-offs of Guideline-Based Categorisation for Ischaemic Stroke Outcome Prediction

arXiv: https://arxiv.org/abs/2608.05203 · HTML: https://mlsanity.com/paper/2608.05203/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 2 of its 20 references that are in the map.
- First posted on arXiv 5 Aug 2026.

## Builds on (most cited first, 2 of 2)

- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [Ignore, Trust, or Negotiate: Understanding Clinician Acceptance of AI-Based Treatment Recommendations in Health Care](https://mlsanity.com/paper/2302.00096/) (2023)

## Abstract (arXiv)

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.