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17 Optimizing trauma prognostication via machine learning: Automating frailty detection in geriatric trauma patients

Published online by Cambridge University Press:  11 April 2025

Maya Carter
Affiliation:
West Virginia University - WVCTSI
Tyler McGaughey
Affiliation:
West Virginia University - WVCTSI
James Bardes
Affiliation:
West Virginia University - WVCTSI
Maryam Khodaverdi
Affiliation:
West Virginia University - WVCTSI
Noah Adler
Affiliation:
West Virginia University - WVCTSI
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Abstract

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Objectives/Goals: This study evaluates the role of visual machine learning algorithms (VMLA) in automating a predictive model of central sarcopenia in geriatric trauma patients based on the psoas:lumbar vertebral index (PLVI) and trauma-specific frailty index (TSFI). Methods/Study Population: 150 trauma patients seen at Jon Michael Moore Trauma Center within J.W Ruby Memorial Hospital in rural West Virginia were included in this investigation across the life spectrum. The VMLA was trained on their standard of care trauma panoramic CT scans. Five expert reviewers segmented bilateral psoas muscles and the L4 vertebrae of each CT image at one slice inferior to the posterior elements of the L4 vertebrae. The data were read into a U-net convoluted neural network as ground truth. Labels were preprocessed to focus on the regions of interest and standardized into four classes: right psoas, left psoas, L4 vertebrae, and background. Performance was evaluated using accuracy, Dice coefficient, and F1 score. Results/Anticipated Results: Between our expert reviewer segmentations, we had significant inter-reader reliability with a Kappa greater than 0.8 and a mean standard deviation of the PLVI of 0.10mm^2. Preliminary VMLA testing on a subset of 70 patients yielded a validation accuracy of 88.5%, a Dice coefficient of 0.86, and an F1 score of 0.87 after 20 epochs. There was a moderate interclass correlation between PLVI and TSFI even though the TSFI lacks sensitivity. In fact, the PLVI is a more accurate predictor of frailty in trauma patients based on various outcome measures such as corrected length of stay. Our ongoing efforts are centered around improving the VMLA. Discussion/Significance of Impact: Our VMLA outperforms the current clinical standard, TSFI. Integration of our VMLA into the clinical workflow has the potential to revolutionize geriatric trauma care by providing rapid, accurate, identification of high-risk frail patients.

Type
Informatics, AI and Data Science
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2025. The Association for Clinical and Translational Science