Performance of Machine Learning Algorithms in Predicting Prolonged Mechanical Ventilation in Patients with Blunt Chest Trauma

Yifei Chen,1,* Xiaoning Lu,2,* Yuefei Zhang,2,* Yang Bao,3 Yong Li,4 Bing Zhang1 1Department of Emergency Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, People’s Republic of China; 2Department of Cardiothoracic Surgery, The affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, People’s Republic of China; 3Department of Cardiothoracic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, People’s Republic of China; 4Trauma Medical Center, Affiliated Hospital of Yangzhou University, Yangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yong Li, Trauma Medical Center, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, 225000, People’s Republic of China, Email [email protected] Bing Zhang, Department of Emergency Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, 225000, People’s Republic of China, Email [email protected]: Mechanical ventilation (MV) is one of the most common treatments for patients with blunt chest trauma (BCT) admitted to the intensive care unit (ICU). Our study aimed to investigate the performance of machine learning algorithms in predicting the prolonged duration of mechanical ventilation (PDMV) in patients with BCT.Methods: In this single-center observational study, patients with BCT who were treated with MV through nasal or oral intubation were selected. PDMV was defined as the duration of mechanical ventilation ≥ 7 days after endotracheal intubation (normal vs prolonged MV; dichotomous outcomes). K-means was used to cluster data from the original cohort by an unsupervised learning method. Multiple machine learning algorithms were used to predict DMV categories. The most significant predictors were identified by feature importance analysis. Finally, a decision tree based on the chi-square automatic interaction detection (CHAID) algorithm was developed to study the cutoff points of predictors in clinical decision-making.Results: A total of 426 patients and 35 characteristics were included. K-means clustering divided the cohort into two clusters (high risk and low risk). The area under the curve (AUC) of the DMV classification algorithms ranged from 0.753 to 0.923. The importance analysis showed that the volume of pulmonary contusion (VPC) was the most important feature to predict DMV. The prediction accuracy of the decision tree based on CHAID reached 86.4%.Conclusion: Machine learning algorithms can predict PDMV in patients with BCT. Therefore, limited medical resources can be more appropriately allocated to BCT patients at risk for PDMV.Keywords: mechanical ventilation, blunt chest trauma, machine learning, pulmonary contusion