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A New Time-Window Prediction Model For Traumatic Hemorrhagic Shock Based on Interpretable Machine Learning

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单位: [1]Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China [2]School of Economics and Management, Beijing Jiaotong University, Beijing, China [3]Management School, Beijing Union University, Beijing, China [4]Washington University in St. Louis [5]Department of Emergency, Armed Police Characteristic Medical Center, Tianjin, China [6]College of Computer Science and Artificial Intelligence, Wenzhou University [7]Beijing Friendship Hospital, Capital Medical University, Beijing, China [8]Department of Emergency, The Third Medical Center of Chinese PLA General Hospital, Beijing, China [9]Hainan Hospital of Chinese PLA General Hospital, Sanya, China
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关键词: Interpretability machine learning prediction window shock index time series traumatic hemorrhagic shock

摘要:
Early warning prediction of traumatic hemorrhagic shock (THS) can greatly reduce patient mortality and morbidity. We aimed to develop and validate models with different stepped feature sets to predict THS in advance. From the PLA General Hospital Emergency Rescue Database and Medical Information Mart for Intensive Care III, we identified 604 and 1,614 patients, respectively. Two popular machine learning algorithms (i.e., extreme gradient boosting [XGBoost] and logistic regression) were applied. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of the models. By analyzing the feature importance based on XGBoost, we found that features in vital signs (VS), routine blood (RB), and blood gas analysis (BG) were the most relevant to THS (0.292, 0.249, and 0.225, respectively). Thus, the stepped relationships existing in them were revealed. Furthermore, the three stepped feature sets (i.e., VS, VS + RB, and VS + RB + sBG) were passed to the two machine learning algorithms to predict THS in the subsequent T hours (where T = 3, 2, 1, or 0.5), respectively. Results showed that the XGBoost model performance was significantly better than the logistic regression. The model using vital signs alone achieved good performance at the half-hour time window (AUROC = 0.935), and the performance was increased when laboratory results were added, especially when the time window was 1 h (AUROC = 0.950 and 0.968, respectively). These good-performing interpretable models demonstrated acceptable generalization ability in external validation, which could flexibly and rollingly predict THS T hours (where T = 0.5, 1) prior to clinical recognition. A prospective study is necessary to determine the clinical utility of the proposed THS prediction models.

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出版当年[2021]版:
大类 | 2 区 医学
小类 | 2 区 外科 3 区 危重病医学 3 区 血液学 3 区 外周血管病
最新[2025]版:
大类 | 3 区 医学
小类 | 3 区 血液学 3 区 外周血管病 3 区 外科 4 区 危重病医学
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出版当年[2020]版:
Q2 HEMATOLOGY Q2 PERIPHERAL VASCULAR DISEASE Q2 CRITICAL CARE MEDICINE Q2 SURGERY
最新[2023]版:
Q1 SURGERY Q2 CRITICAL CARE MEDICINE Q2 HEMATOLOGY Q2 PERIPHERAL VASCULAR DISEASE

影响因子: 最新[2023版] 最新五年平均[2021-2025] 出版当年[2020版] 出版当年五年平均[2016-2020] 出版前一年[2019版] 出版后一年[2021版]

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第一作者单位: [1]Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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通讯机构: [1]Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China [2]School of Economics and Management, Beijing Jiaotong University, Beijing, China [8]Department of Emergency, The Third Medical Center of Chinese PLA General Hospital, Beijing, China [9]Hainan Hospital of Chinese PLA General Hospital, Sanya, China [*1]School of Economics and Management, Beijing Jiaotong University, Beijing, China. [*2]Department of Emergency, The Third Medical Center of Chinese PLA General Hospital, Beijing, China Department of Emergency, Hainan Hospital of Chinese PLA General Hospital, Sanya, China. [*3]Department of Emergency, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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