Background: Acute kidney injury (AKI), the decline of kidney excretory function, occurs in up to 18% of hospitalized admissions. Progression of AKI may lead to irreversible kidney damage. Methods: This retrospective cohort study includes adult patients admitted to a non-intensive care unit at the University of Pittsburgh Medical Center (UPMC) (n = 46,815) and University of Florida Health (UFH) (n = 127,202). We developed and compared deep learning and conventional machine learning models to predict progression to Stage 2 or higher AKI within the next 48 hours. We trained local models for each site (UFH Model trained on UFH, UPMC Model trained on UPMC) and a separate model with a development cohort of patients from both sites (UFH-UPMC Model). We internally and externally validated the models on each site and performed subgroup analyses across sex and race. Results: Stage 2 or higher AKI occurred in 3% (n=3,257) and 8% (n=2,296) of UFH and UPMC patients, respectively. Area under the receiver operating curve values (AUROC) for the UFH test cohort ranged between 0.77 (UPMC Model) and 0.81 (UFH Model), while AUROC values ranged between 0.79 (UFH Model) and 0.83 (UPMC Model) for the UPMC test cohort. UFH-UPMC Model achieved an AUROC of 0.81 (95% confidence interval [CI] [0.80, 0.83]) for UFH and 0.82 (95% CI [0.81,0.84]) for UPMC test cohorts; an area under the precision recall curve values (AUPRC) of 0.6 (95% CI, [0.05, 0.06]) for UFH and 0.13 (95% CI, [0.11,0.15]) for UPMC test cohorts. Kinetic estimated glomerular filtration rate, nephrotoxic drug burden and blood urea nitrogen remained the top three features with the highest influence across the models and health centers. Conclusion: Locally developed models displayed marginally reduced discrimination when tested on another institution, while the top set of influencing features remained the same across the models and sites.
The relationship between acute kidney injury (AKI) prediction and nephrotoxic drugs, or drugs that adversely affect kidney function, is one that has yet to be explored in the critical care setting. One contributing factor to this gap in research is the limited investigation of drug modalities in the intensive care unit (ICU) context, due to the challenges of processing prescription data into the corresponding drug representations and a lack in the comprehensive understanding of these drug representations. This study addresses this gap by proposing a novel approach that leverages patient prescription data as a modality to improve existing models for AKI prediction. We base our research on Electronic Health Record (EHR) data, extracting the relevant patient prescription information and converting it into the selected drug representation for our research, the extended-connectivity fingerprint (ECFP). Furthermore, we adopt a unique multimodal approach, developing machine learning models and 1D Convolutional Neural Networks (CNN) applied to clinical drug representations, establishing a procedure which has not been used by any previous studies predicting AKI. The findings showcase a notable improvement in AKI prediction through the integration of drug embeddings and other patient cohort features. By using drug features represented as ECFP molecular fingerprints along with common cohort features such as demographics and lab test values, we achieved a considerable improvement in model performance for the AKI prediction task over the baseline model which does not include the drug representations as features, indicating that our distinct approach enhances existing baseline techniques and highlights the relevance of drug data in predicting AKI in the ICU setting
Since the World Health Organization declared COVID-19 a pandemic in 2020, the global community has faced ongoing challenges in controlling and mitigating the transmission of the SARS-CoV-2 virus, as well as its evolving subvariants and recombinants. A significant challenge during the pandemic has not only been the accurate detection of positive cases but also the efficient prediction of risks associated with complications and patient survival probabilities. These tasks entail considerable clinical resource allocation and attention.In this study, we introduce COVID-Net Biochem, a versatile and explainable framework for constructing machine learning models. We apply this framework to predict COVID-19 patient survival and the likelihood of developing Acute Kidney Injury during hospitalization, utilizing clinical and biochemical data in a transparent, systematic approach. The proposed approach advances machine learning model design by seamlessly integrating domain expertise with explainability tools, enabling model decisions to be based on key biomarkers. This fosters a more transparent and interpretable decision-making process made by machines specifically for medical applications.
Traumatic brain injury can be caused by various types of head impacts. However, due to different kinematic characteristics, many brain injury risk estimation models are not generalizable across the variety of impacts that humans may sustain. The current definitions of head impact subtypes are based on impact sources (e.g., football, traffic accident), which may not reflect the intrinsic kinematic similarities of impacts across the impact sources. To investigate the potential new definitions of impact subtypes based on kinematics, 3,161 head impacts from various sources including simulation, college football, mixed martial arts, and car racing were collected. We applied the K-means clustering to cluster the impacts on 16 standardized temporal features from head rotation kinematics. Then, we developed subtype-specific ridge regression models for cumulative strain damage (using the threshold of 15%), which significantly improved the estimation accuracy compared with the baseline method which mixed impacts from different sources and developed one model (R^2 from 0.7 to 0.9). To investigate the effect of kinematic features, we presented the top three critical features (maximum resultant angular acceleration, maximum angular acceleration along the z-axis, maximum linear acceleration along the y-axis) based on regression accuracy and used logistic regression to find the critical points for each feature that partitioned the subtypes. This study enables researchers to define head impact subtypes in a data-driven manner, which leads to more generalizable brain injury risk estimation.
Developing an accurate and reliable injury predictor is central to the biomechanical studies of traumatic brain injury. State-of-the-art efforts continue to rely on empirical, scalar metrics based on kinematics or model-estimated tissue responses explicitly pre-defined in a specific brain region of interest. They could suffer from loss of information. A single training dataset has also been used to evaluate performance but without cross-validation. In this study, we developed a deep learning approach for concussion classification using implicit features of the entire voxel-wise white matter fiber strains. Using reconstructed American National Football League (NFL) injury cases, leave-one-out cross-validation was employed to objectively compare injury prediction performances against two baseline machine learning classifiers (support vector machine (SVM) and random forest (RF)) and four scalar metrics via univariate logistic regression (Brain Injury Criterion (BrIC), cumulative strain damage measure of the whole brain (CSDM-WB) and the corpus callosum (CSDM-CC), and peak fiber strain in the CC). Feature-based deep learning and machine learning classifiers consistently outperformed all scalar injury metrics across all performance categories in cross-validation (e.g., average accuracy of 0.844 vs. 0.746, and average area under the receiver operating curve (AUC) of 0.873 vs. 0.769, respectively, based on the testing dataset). Nevertheless, deep learning achieved the best cross-validation accuracy, sensitivity, and AUC (e.g., accuracy of 0.862 vs. 0.828 and 0.842 for SVM and RF, respectively). These findings demonstrate the superior performances of deep learning in concussion prediction, and suggest its promise for future applications in biomechanical investigations of traumatic brain injury.
Intimate partner violence (IPV) is an urgent, prevalent, and under-detected public health issue. We present machine learning models to assess patients for IPV and injury. We train the predictive algorithms on radiology reports with 1) IPV labels based on entry to a violence prevention program and 2) injury labels provided by emergency radiology fellowship-trained physicians. Our dataset includes 34,642 radiology reports and 1479 patients of IPV victims and control patients. Our best model predicts IPV a median of 3.08 years before violence prevention program entry with a sensitivity of 64% and a specificity of 95%. We conduct error analysis to determine for which patients our model has especially high or low performance and discuss next steps for a deployed clinical risk model.
Head motion induced by impacts has been deemed as one of the most important measures in brain injury prediction, given that the majority of brain injury metrics use head kinematics as input. Recently, researchers have focused on using fast approaches, such as machine learning, to approximate brain deformation in real-time for early brain injury diagnosis. However, those requires large number of kinematic measurements, and therefore data augmentation is required given the limited on-field measured data available. In this study we present a principal component analysis-based method that emulates an empirical low-rank substitution for head impact kinematics, while requiring low computational cost. In characterizing our existing data set of 537 head impacts, consisting of 6 degrees of freedom measurements, we found that only a few modes, e.g. 15 in the case of angular velocity, is sufficient for accurate reconstruction of the entire data set. Furthermore, these modes are predominantly low frequency since over 70% to 90% of the angular velocity response can be captured by modes that have frequencies under 40Hz. We compared our proposed method against existing impact parametrization methods and showed significantly better performance in injury prediction using a range of kinematic-based metrics -- such as head injury criterion and rotational injury criterion (RIC) -- and brain tissue deformation-metrics -- such as brain angle metric, maximum principal strain (MPS) and axonal fiber strains (FS). In all cases, our approach reproduced injury metrics similar to the ground truth measurements with no significant difference, whereas the existing methods obtained significantly different (p<0.01) values as well as poor injury classification sensitivity and specificity. This emulator will enable us to provide the necessary data augmentation to build a head impact kinematic data set of any size.
This paper significantly improves on, and finishes to validate, an approach proposed in previous research in which safety outcomes were predicted from attributes with machine learning. Like in the original study, we use Natural Language Processing (NLP) to extract fundamental attributes from raw incident reports and machine learning models are trained to predict safety outcomes. The outcomes predicted here are injury severity, injury type, body part impacted, and incident type. However, unlike in the original study, safety outcomes were not extracted via NLP but were provided by independent human annotations, eliminating any potential source of artificial correlation between predictors and predictands. Results show that attributes are still highly predictive, confirming the validity of the original approach. Other improvements brought by the current study include the use of (1) a much larger dataset featuring more than 90,000 reports, (2) two new models, XGBoost and linear SVM (Support Vector Machines), (3) model stacking, (4) a more straightforward experimental setup with more appropriate performance metrics, and (5) an analysis of per-category attribute importance scores. Finally, the injury severity outcome is well predicted, which was not the case in the original study. This is a significant advancement.
Computer Tomography (CT) is the gold standard technique for brain damage evaluation after acute Traumatic Brain Injury (TBI). It allows identification of most lesion types and determines the need of surgical or alternative therapeutic procedures. However, the traditional approach for lesion classification is restricted to visual image inspection. In this work, we characterize and predict TBI lesions by using CT-derived radiomics descriptors. Relevant shape, intensity and texture biomarkers characterizing the different lesions are isolated and a lesion predictive model is built by using Partial Least Squares. On a dataset containing 155 scans (105 train, 50 test) the methodology achieved 89.7 % accuracy over the unseen data. When a model was build using only texture features, a 88.2 % accuracy was obtained. Our results suggest that selected radiomics descriptors could play a key role in brain injury prediction. Besides, the proposed methodology is close to reproduce radiologists decision making. These results open new possibilities for radiomics-inspired brain lesion detection, segmentation and prediction.
The goal of this thesis is to investigate the potential of predictive modelling for football injuries. This work was conducted in close collaboration with Tottenham Hotspurs FC (THFC), the PGA European tour and the participation of Wolverhampton Wanderers (WW). Three investigations were conducted: 1. Predicting the recovery time of football injuries using the UEFA injury recordings: The UEFA recordings is a common standard for recording injuries in professional football. For this investigation, three datasets of UEFA injury recordings were available. Different machine learning algorithms were used in order to build a predictive model. The performance of the machine learning models is then improved by using feature selection conducted through correlation-based subset feature selection and random forests. 2. Predicting injuries in professional football using exposure records: The relationship between exposure (in training hours and match hours) in professional football athletes and injury incidence was studied. A common problem in football is understanding how the training schedule of an athlete can affect the chance of him getting injured. The task was to predict the number of days a player can train before he gets injured. 3. Predicting intrinsic injury incidence using in-training GPS measurements: A significant percentage of football injuries can be attributed to overtraining and fatigue. GPS data collected during training sessions might provide indicators of fatigue, or might be used to detect very intense training sessions which can lead to overtraining. This research used GPS data gathered during training sessions of the first team of THFC, in order to predict whether an injury would take place during a week.
To investigate whether training load monitoring data could be used to predict injuries in elite Australian football players, data were collected from elite athletes over 3 seasons at an Australian football club. Loads were quantified using GPS devices, accelerometers and player perceived exertion ratings. Absolute and relative training load metrics were calculated for each player each day (rolling average, exponentially weighted moving average, acute:chronic workload ratio, monotony and strain). Injury prediction models (regularised logistic regression, generalised estimating equations, random forests and support vector machines) were built for non-contact, non-contact time-loss and hamstring specific injuries using the first two seasons of data. Injury predictions were generated for the third season and evaluated using the area under the receiver operator characteristic (AUC). Predictive performance was only marginally better than chance for models of non-contact and non-contact time-loss injuries (AUC$<$0.65). The best performing model was a multivariate logistic regression for hamstring injuries (best AUC=0.76). Learning curves suggested logistic regression was underfitting the load-injury relationship and that using a more complex model or increasing the amount of model building data may lead to future improvements. Injury prediction models built using training load data from a single club showed poor ability to predict injuries when tested on previously unseen data, suggesting they are limited as a daily decision tool for practitioners. Focusing the modelling approach on specific injury types and increasing the amount of training data may lead to the development of improved predictive models for injury prevention.