Clinical performance of automated machine learning: A systematic review.

Introduction: Automated machine learning (autoML) removes technical and technological barriers to building artificial intelligence models. We aimed to summarise the clinical applications of autoML, assess the capabilities of utilised platforms, evaluate the quality of the evidence trialling autoML, and gauge the performance of autoML platforms relative to conventionally developed models, as well as each other.
Method: This review adhered to a prospectively registered protocol (PROSPERO identifier CRD42022344427). The Cochrane Library, Embase, MEDLINE and Scopus were searched from inception to 11 July 2022. Two researchers screened abstracts and full texts, extracted data and conducted quality assessment. Disagreement was resolved through discussion and if required, arbitration by a third researcher.
Results: There were 26 distinct autoML platforms featured in 82 studies. Brain and lung disease were the most common fields of study of 22 specialties. AutoML exhibited variable performance: area under the receiver operator characteristic curve (AUCROC) 0.35-1.00, F1-score 0.16-0.99, area under the precision-recall curve (AUPRC) 0.51-1.00. AutoML exhibited the highest AUCROC in 75.6% trials; the highest F1-score in 42.3% trials; and the highest AUPRC in 83.3% trials. In autoML platform comparisons, AutoPrognosis and Amazon Rekognition performed strongest with unstructured and structured data, respectively. Quality of reporting was poor, with a median DECIDE-AI score of 14 of 27.
Conclusion: A myriad of autoML platforms have been applied in a variety of clinical contexts. The performance of autoML compares well to bespoke computational and clinical benchmarks. Further work is required to improve the quality of validation studies. AutoML may facilitate a transition to data-centric development, and integration with large language models may enable AI to build itself to fulfil user-defined goals.
Competing Interests: AJT is supported by The Royal College of Surgeons in Edinburgh (RCSED Bursary 2022), Royal College of Physicians (MSEB 2022), and Corpus Christi College, University of Cambridge (Gordon Award 1083874682). DSWT is supported by the National Medical Research Council, Singapore (NMCR/ HSRG/0087/2018; MOH-000655-00; MOH- 001014-00), Duke-NUS Medical School (Duke- NUS/RSF/2021/0018; 05/FY2020/EX/15-A58), and Agency for Science, Technology and Research (A20H4g2141; H20C6a0032). These funders were not involved in the conception, execution or reporting of this study. All authors declare no competing interests.