Discharge prediction of critical patients with spinal cord injury: a machine learning study with 1485 cases

Objectives Prognostication of spinal cord injury (SCI) is vital, especially for critical patients who need intensive care. The study aims to develop machine-learning (ML) classifiers for discharge prediction of SCI patients in the intensive care unit (ICU). Methods Clinical data of patients diagnosed with SCI were extracted from the publicly available ICU database. A total of 105 ML classifiers were initially developed to predict the discharge destination (dead, further medical care, home), and then the top 3 classifiers with the best performance were stacked into an ensemble classifier (Esb-Clf). To balance the accuracy and the feasibility, the complete Esb-Clf was finally simplified with top 10 features (simplified Esb-Clf). The micro-average area under the curve (AUC) was used to compare the prediction performance of difference ML classifiers and 6 doctors’ artificial prediction. Results A total of 1485 SCI patients were used for the early and the recent prediction of discharge destination. In the early prediction, the micro-average AUC of the Esb-Clf and the simplified Esb-Clf was 0.846 and 0.835 during the independent testing, respectively. While in the recent prediction, the micro-average AUC of the Esb-Clf and the simplified Esb-Clf was 0.898 and 0.892. Performance of both the Esb-Clf and the simplified Esb-Clf were superior to the doctors’ in the early and the recent prediction. Conclusions ML classifiers can discriminate the discharge destination of SCI patients with high accuracy, feasibility and interpretability. Whether the simplified Esb-Clf as an online predictive tool is applicable to guiding clinical management needs further verification.