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The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach

When a patient is admitted to the intensive care unit (ICU) after a traumatic brain injury (TBI), an early prognosis is essential for baseline risk adjustment and shared decision making. TBI outcomes are commonly categorised by the Glasgow Outcome Scale–Extended (GOSE) into eight, ordered levels of...

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Autores principales: Bhattacharyay, Shubhayu, Milosevic, Ioan, Wilson, Lindsay, Menon, David K., Stevens, Robert D., Steyerberg, Ewout W., Nelson, David W., Ercole, Ari
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9255749/
https://www.ncbi.nlm.nih.gov/pubmed/35788768
http://dx.doi.org/10.1371/journal.pone.0270973
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author Bhattacharyay, Shubhayu
Milosevic, Ioan
Wilson, Lindsay
Menon, David K.
Stevens, Robert D.
Steyerberg, Ewout W.
Nelson, David W.
Ercole, Ari
author_facet Bhattacharyay, Shubhayu
Milosevic, Ioan
Wilson, Lindsay
Menon, David K.
Stevens, Robert D.
Steyerberg, Ewout W.
Nelson, David W.
Ercole, Ari
author_sort Bhattacharyay, Shubhayu
collection PubMed
description When a patient is admitted to the intensive care unit (ICU) after a traumatic brain injury (TBI), an early prognosis is essential for baseline risk adjustment and shared decision making. TBI outcomes are commonly categorised by the Glasgow Outcome Scale–Extended (GOSE) into eight, ordered levels of functional recovery at 6 months after injury. Existing ICU prognostic models predict binary outcomes at a certain threshold of GOSE (e.g., prediction of survival [GOSE > 1]). We aimed to develop ordinal prediction models that concurrently predict probabilities of each GOSE score. From a prospective cohort (n = 1,550, 65 centres) in the ICU stratum of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) patient dataset, we extracted all clinical information within 24 hours of ICU admission (1,151 predictors) and 6-month GOSE scores. We analysed the effect of two design elements on ordinal model performance: (1) the baseline predictor set, ranging from a concise set of ten validated predictors to a token-embedded representation of all possible predictors, and (2) the modelling strategy, from ordinal logistic regression to multinomial deep learning. With repeated k-fold cross-validation, we found that expanding the baseline predictor set significantly improved ordinal prediction performance while increasing analytical complexity did not. Half of these gains could be achieved with the addition of eight high-impact predictors to the concise set. At best, ordinal models achieved 0.76 (95% CI: 0.74–0.77) ordinal discrimination ability (ordinal c-index) and 57% (95% CI: 54%– 60%) explanation of ordinal variation in 6-month GOSE (Somers’ D(xy)). Model performance and the effect of expanding the predictor set decreased at higher GOSE thresholds, indicating the difficulty of predicting better functional outcomes shortly after ICU admission. Our results motivate the search for informative predictors that improve confidence in prognosis of higher GOSE and the development of ordinal dynamic prediction models.
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spelling pubmed-92557492022-07-06 The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach Bhattacharyay, Shubhayu Milosevic, Ioan Wilson, Lindsay Menon, David K. Stevens, Robert D. Steyerberg, Ewout W. Nelson, David W. Ercole, Ari PLoS One Research Article When a patient is admitted to the intensive care unit (ICU) after a traumatic brain injury (TBI), an early prognosis is essential for baseline risk adjustment and shared decision making. TBI outcomes are commonly categorised by the Glasgow Outcome Scale–Extended (GOSE) into eight, ordered levels of functional recovery at 6 months after injury. Existing ICU prognostic models predict binary outcomes at a certain threshold of GOSE (e.g., prediction of survival [GOSE > 1]). We aimed to develop ordinal prediction models that concurrently predict probabilities of each GOSE score. From a prospective cohort (n = 1,550, 65 centres) in the ICU stratum of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) patient dataset, we extracted all clinical information within 24 hours of ICU admission (1,151 predictors) and 6-month GOSE scores. We analysed the effect of two design elements on ordinal model performance: (1) the baseline predictor set, ranging from a concise set of ten validated predictors to a token-embedded representation of all possible predictors, and (2) the modelling strategy, from ordinal logistic regression to multinomial deep learning. With repeated k-fold cross-validation, we found that expanding the baseline predictor set significantly improved ordinal prediction performance while increasing analytical complexity did not. Half of these gains could be achieved with the addition of eight high-impact predictors to the concise set. At best, ordinal models achieved 0.76 (95% CI: 0.74–0.77) ordinal discrimination ability (ordinal c-index) and 57% (95% CI: 54%– 60%) explanation of ordinal variation in 6-month GOSE (Somers’ D(xy)). Model performance and the effect of expanding the predictor set decreased at higher GOSE thresholds, indicating the difficulty of predicting better functional outcomes shortly after ICU admission. Our results motivate the search for informative predictors that improve confidence in prognosis of higher GOSE and the development of ordinal dynamic prediction models. Public Library of Science 2022-07-05 /pmc/articles/PMC9255749/ /pubmed/35788768 http://dx.doi.org/10.1371/journal.pone.0270973 Text en © 2022 Bhattacharyay et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Bhattacharyay, Shubhayu
Milosevic, Ioan
Wilson, Lindsay
Menon, David K.
Stevens, Robert D.
Steyerberg, Ewout W.
Nelson, David W.
Ercole, Ari
The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach
title The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach
title_full The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach
title_fullStr The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach
title_full_unstemmed The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach
title_short The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach
title_sort leap to ordinal: detailed functional prognosis after traumatic brain injury with a flexible modelling approach
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9255749/
https://www.ncbi.nlm.nih.gov/pubmed/35788768
http://dx.doi.org/10.1371/journal.pone.0270973
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