Hybrid novice-AI system achieves expert-level performance in intraoperative ischemia detection

Carotid endarterectomy carries the risk of intraoperative cerebral ischemia, which is monitored by expert neurophysiologists through continuous electroencephalography (cEEG). Because expert availability is limited, we developed a hybrid novice-artificial intelligence (AI) system that detects ischemia using novice monitors with limited cEEG training. The hybrid system dynamically weights novice and AI inputs to arrive at a final output. Using four novices, we compared hybrid systems against experts alone, novices alone, and AI alone. Hybrid systems were statistically non-inferior to experts in sensitivity and false-positive rate (FPR), whereas novices alone were not. At 80% sensitivity, hybrid systems reduced FPR by half compared with the AI-only system, with similar benefits at 90% sensitivity. Further, the area under the precision-recall curve improved from 0.546 to 0.610-0.726, the area under the receiver operating characteristic curve improved from 0.957 to 0.967-0.971, and calibration improved compared with AI alone. These results highlight the potential of a hybrid system to monitor intraoperative cerebral ischemia.