Toward a hemorrhagic trauma severity score: fusing five physiological biomarkers
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Journal of Translational Medicine Open Access
RESEARCH
Toward a hemorrhagic trauma severity score: fusing five physiological biomarkers Ankita Bhat1 , Daria Podstawczyk2 , Brandon K. Walther1,3 , John R. Aggas1 , David Machado‑Aranda4,5 , Kevin R. Ward5 and Anthony Guiseppi‑Elie1,3,6,7*
Abstract Background: To introduce the Hemorrhage Intensive Severity and Survivability (HISS) score, based on the fusion of multi-biomarker data; glucose, lactate, pH, potassium, and oxygen tension, to serve as a patient-specific attribute in hemorrhagic trauma. Materials and methods: One hundred instances of Sensible Fictitious Rationalized Patient (SFRP) data were synthet‑ ically generated and the HISS score assigned by five clinically active physician experts (100 [5]). The HISS score strati‑ fies the criticality of the trauma patient as; low(0), guarded(1), elevated(2), high(3) and severe(4). Standard classifier algorithms; linear support vector machine (SVM-L), multi-class ensemble bagged decision tree (EBDT), artificial neural network with bayesian regularization (ANN:BR) and possibility rule-based using function approximation (PRBF) were evaluated for their potential to similarly classify and predict a HISS score. Results: SVM-L, EBDT, ANN:BR and PRBF generated score predictions with testing accuracies (majority vote) corre‑ sponding to 0.91 ± 0.06, 0.93 ± 0.04, 0.92 ± 0.07, and 0.92 ± 0.03, respectively, with no statistically significant difference (p > 0.05). Targeted accuracies of 0.99 and 0.999 could be achieved with SFRP data size and clinical expert scores of 147[7](0.99) and 154[9](0.999), respectively. Conclusions: The predictions of the data-driven model in conjunction with an adjunct multi-analyte biosen‑ sor intended for point-of-care continual monitoring of trauma patients, can aid in patient stratification and triage decision-making. Keywords: Decision-making, Hemorrhage, Trauma care, DATA fusion, Risk stratification, Triage Background Trauma accounts for 47% of mortalities in individuals 1–46 years of age in the United States [1, 2]. Traumainduced hemorrhage with its attendant peripheral vasoconstriction [3, 4] insulin resistance [5], hyperlactatemia, [6–8] acidosis [9], hyperkalemia [10, 11] and hypoxia can rapidly lead to death or may be followed by Multiple Organ Dysfunction Syndrome (MODS), a consequence *Correspondence: [email protected] 1 Center for Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA Full list of author information is available at the end of the article
of a “cytokine storm”, which can also be fatal [9, 12]. The field triage decision scheme for the national trauma triage protocol provides guidelines to identify the status of the patient [13]. The physiological criteria includes identification of vital signs such as; systolic blood pressure (Hypotension 100 beats per minute) [17], and the Glasgow coma scale (≤ 13) [18, 19]. The Glasgow coma scale categorizes the patients according to the s
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