Hip fracture prediction from a new classification algorithm based on recursive partitioning methods

Abstract

Classification and regression tree has been useful in medical research to construct algorithms for disease diagnosis or prognostic prediction. Jin et al. 7 developed a robust and cost-saving tree (RACT) algorithm with application in classification of hip fracture risk after 5-year follow-up based on the data from the Study of Osteoporotic Fractures (SOF). Although conventional recursive partitioning algorithms have been well developed, they still have some limitations. Binary splits may generate a big tree with many layers, but trinary splits may produce too many nodes. In this paper, we propose a classification approach combining trinary splits and binary splits to generate a trinary–binary tree. A new non-inferiority test of entropy is used to select the binary or trinary splits. We apply the modified method in SOF to construct a trinary–binary classification rule for predicting risk of osteoporotic hip fracture. Our new classification tree has good statistical utility: it is statistically non-inferior to the optimum binary tree and the RACT based on the testing sample and is also cost-saving. It may be useful in clinical applications: femoral neck bone mineral density, age, height loss and weight gain since age 25 can identify subjects with elevated 5-year hip fracture risk without loss of statistical efficiency.

Keywords:

• classification tree
• binary split
• trinary split
• non-inferior
• hip fracture risk