Development of predictive model for the neurological deterioration among mild traumatic brain injury patients using machine learning algorithms.

BACKGROUND

Mild traumatic brain injury (mTBI) comprises a majority of traumatic brain injury (TBI) cases. While some mTBI would suffer neurological deterioration (ND) and therefore have poorer prognosis. This study was designed to develop the predictive model for the ND among mTBI using machine learning algorithms.

METHODS

mTBI patients recorded in the Medical Information Mart for Intensive Care-III were selected for the study. The ND was defined as a drop of Glasgow Coma Scale ≥ 2 within the first 7 day after admission. Eight machine learning algorithms were trained and validated with 5-fold cross validation including extreme gradient boosting, logistic regression, light gradient boosting machine, random forest, adaptive boosting, decision tree, complement naïve Bayes, and support vector machine. The value of eight machine learning algorithms was compared by the area under the receiver operating characteristic curve (AUC).

RESULTS

361 mTBI patients suffered the ND with the incidence of 30.7%. The ND group had higher 30-day mortality (p = 0.001). In the training cohort of mTBI patients, the random forest performed the best on predicting the ND with the AUC of 1.000. The XGBoost and AdaBoost had an AUC of 0.827 and 0.815, respectively. The logistic regression performed the best on predicting the ND in the validation cohort with the AUC of 0.741. The XGBoost, random forest and AdaBoost had an AUC of 0.729, 0.735, 0.736 in the validation cohort, respectively. After adjusting confounding effects, the multivariate logistic regression found only two independent risk factors for the ND including Sequential Organ Failure Assessment (SOFA) (p < 0.001) and hypertension (p = 0.001). The logistic regression predictive model composed of SOFA and hypertension had an AUC of 0.741.

CONCLUSIONS

SOFA score and complicated hypertension are two independent risk factors for the neurological deterioration among mTBI patients. The logistic regression predictive model incorporating SOFA and hypertension is helpful to identify mTBI patients with the high risk of ND.