Machine Learning Model to Predict Ventilator Associated Pneumonia in patients with Traumatic Brain Injury: The C.5 Decision Tree Approach

ABSTRACT

Background

There is paucity in the literature to predict the occurrence of Ventilator Associated Pneumonia (VAP) in patients with Traumatic Brain Injury (TBI). We aimed to build a C.5. Decision Tree (C.5 DT) machine learning model to predict VAP in patients with moderate to severe TBI.

Methods

This was a retrospective study including all adult patients who were hospitalized with TBI plus head abbreviated injury scale (AIS) ≥ 3 and were mechanically ventilated in a level 1 trauma center between 2014 and 2019.

Results

A total of 772 eligible patients were enrolled, of them 169 had VAP (22%). The C.5 DT model achieved moderate performance with 83.5% accuracy, 80.5% area under the curve, 71% precision, 86% negative predictive value, 43% sensitivity, 95% specificity and 54% F-score. Out of 24 predictors, C.5 DT identified 5 variables predicting occurrence of VAP post-moderate to severe TBI (Time from injury to emergency department arrival, blood transfusion during resuscitation, comorbidities, Injury Severity Score and pneumothorax).

Conclusions

This study could serve as baseline for the quest of predicting VAP in patients with TBI through the utilization of C.5. DT machine learning approach. This model helps provide timely decision support to caregivers to improve patient’s outcomes.

KEYWORDS:

• Machine learning
• ventilator-associated pneumonia
• traumatic brain injury
• C.5. decision tree model

Authors’ contribution

All authors have substantial contribution, writing and approval of the manuscript. A Abujaber: Conceptualization, Methodology, Software, Writing- Reviewing and Editing. Adam Fadlalla & Diala Gammoh Software, Validation, Supervision, Reviewing and Editing. A El-Menyar &H Al-Thani: Supervision, Writing- Reviewing and Editing.

Ethical approval

We obtained HMC`s Institutional Review Board (IRB MRC-01-19-106). The study has no direct contact with subjects and patients` data were anonymized. Therefore, the consent was waived.