Traumatic brain injury (TBI) presents a significant public health challenge, often resulting in mortality or lasting disability. Predicting outcomes such as mortality and Functional Status Scale (FSS) scores can enhance treatment strategies and inform clinical decision-making. This study applies supervised machine learning (ML) methods to predict mortality and FSS scores using a real-world dataset of 300 pediatric TBI patients from the University of Colorado School of Medicine. The dataset captures clinical features, including demographics, injury mechanisms, and hospitalization outcomes. Eighteen ML models were evaluated for mortality prediction, and thirteen models were assessed for FSS score prediction. Performance was measured using accuracy, ROC AUC, F1-score, and mean squared error. Logistic regression and Extra Trees models achieved high precision in mortality prediction, while linear regression demonstrated the best FSS score prediction. Feature selection reduced 103 clinical variables to the most relevant, enhancing model efficiency and interpretability. This research highlights the role of ML models in identifying high-risk patients and supporting personalized interventions, demonstrating the potential of data-driven analytics to improve TBI care and integrate into clinical workflows.

Background: Ventilator-associated pneumonia (VAP) in traumatic brain injury (TBI) patients poses a significant mortality risk and imposes a considerable financial burden on patients and healthcare systems. Timely detection and prognostication of VAP in TBI patients are crucial to improve patient outcomes and alleviate the strain on healthcare resources. Methods: We implemented six machine learning models using the MIMIC-III database. Our methodology included preprocessing steps, such as feature selection with CatBoost and expert opinion, addressing class imbalance with the Synthetic Minority Oversampling Technique (SMOTE), and rigorous model tuning through 5-fold cross-validation to optimize hyperparameters. Key models evaluated included SVM, Logistic Regression, Random Forest, XGBoost, ANN, and AdaBoost. Additionally, we conducted SHAP analysis to determine feature importance and performed an ablation study to assess feature impacts on model performance. Results: XGBoost outperformed the baseline models and the best existing literature. We used metrics, including AUC, Accuracy, Specificity, Sensitivity, F1 Score, PPV, and NPV. XGBoost demonstrated the highest performance with an AUC of 0.940 and an Accuracy of 0.875, which are 23.4% and 23.5% higher than the best results in the existing literature, with an AUC of 0.706 and an Accuracy of 0.640, respectively. This enhanced performance underscores the models' effectiveness in clinical settings. Conclusions: This study enhances the predictive modeling of VAP in TBI patients, improving early detection and intervention potential. Refined feature selection and advanced ensemble techniques significantly boosted model accuracy and reliability, offering promising directions for future clinical applications and medical diagnostics research.

Traumatic Brain Injury (TBI) presents a broad spectrum of clinical presentations and outcomes due to its inherent heterogeneity, leading to diverse recovery trajectories and varied therapeutic responses. While many studies have delved into TBI phenotyping for distinct patient populations, identifying TBI phenotypes that consistently generalize across various settings and populations remains a critical research gap. Our research addresses this by employing multivariate time-series clustering to unveil TBI's dynamic intricates. Utilizing a self-supervised learning-based approach to clustering multivariate time-Series data with missing values (SLAC-Time), we analyzed both the research-centric TRACK-TBI and the real-world MIMIC-IV datasets. Remarkably, the optimal hyperparameters of SLAC-Time and the ideal number of clusters remained consistent across these datasets, underscoring SLAC-Time's stability across heterogeneous datasets. Our analysis revealed three generalizable TBI phenotypes ({\alpha}, \b{eta}, and {\gamma}), each exhibiting distinct non-temporal features during emergency department visits, and temporal feature profiles throughout ICU stays. Specifically, phenotype {\alpha} represents mild TBI with a remarkably consistent clinical presentation. In contrast, phenotype \b{eta} signifies severe TBI with diverse clinical manifestations, and phenotype {\gamma} represents a moderate TBI profile in terms of severity and clinical diversity. Age is a significant determinant of TBI outcomes, with older cohorts recording higher mortality rates. Importantly, while certain features varied by age, the core characteristics of TBI manifestations tied to each phenotype remain consistent across diverse populations.

Determining clinically relevant physiological states from multivariate time series data with missing values is essential for providing appropriate treatment for acute conditions such as Traumatic Brain Injury (TBI), respiratory failure, and heart failure. Utilizing non-temporal clustering or data imputation and aggregation techniques may lead to loss of valuable information and biased analyses. In our study, we apply the SLAC-Time algorithm, an innovative self-supervision-based approach that maintains data integrity by avoiding imputation or aggregation, offering a more useful representation of acute patient states. By using SLAC-Time to cluster data in a large research dataset, we identified three distinct TBI physiological states and their specific feature profiles. We employed various clustering evaluation metrics and incorporated input from a clinical domain expert to validate and interpret the identified physiological states. Further, we discovered how specific clinical events and interventions can influence patient states and state transitions.

Self-supervised learning approaches provide a promising direction for clustering multivariate time-series data. However, real-world time-series data often include missing values, and the existing approaches require imputing missing values before clustering, which may cause extensive computations and noise and result in invalid interpretations. To address these challenges, we present a Self-supervised Learning-based Approach to Clustering multivariate Time-series data with missing values (SLAC-Time). SLAC-Time is a Transformer-based clustering method that uses time-series forecasting as a proxy task for leveraging unlabeled data and learning more robust time-series representations. This method jointly learns the neural network parameters and the cluster assignments of the learned representations. It iteratively clusters the learned representations with the K-means method and then utilizes the subsequent cluster assignments as pseudo-labels to update the model parameters. To evaluate our proposed approach, we applied it to clustering and phenotyping Traumatic Brain Injury (TBI) patients in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. Clinical data associated with TBI patients are often measured over time and represented as timeseries variables characterized by missing values and irregular time intervals. We identified three TBI phenotypes that are distinct from one another in terms of clinically significant variables as well as clinical outcomes, including the Extended Glasgow Outcome Scale (GOSE) score, Intensive Care Unit (ICU) length of stay, and mortality rate. The experiments show that the TBI phenotypes identified by SLAC-Time can be potentially used for developing targeted clinical trials and therapeutic strategies. Keywords Self-supervised learning; Clustering; Transformer; Multivariate time-series data; Traumatic brain injury 1. Introduction Multivariate time-series data are frequently observed in many healthcare domains where each patient is represented by a set of clinical measurements recorded over time and present important information spanning the whole course of a patient's care. Clustering approaches are commonly used to extract valuable information and patterns from multivariate time-series data [1]. Such clustering approaches can be broadly divided into two categories: raw data-based approaches and representation-based approaches [2]. Raw data-based approaches perform the clustering on raw input data using well-designed similarity measures that can address the specificities of the temporal dimension, including shifted or stretched patterns (e.g., [3-5]).

University of Pittsburgh School of Medicine data scientists and UPMC neurotrauma surgeons have created a prognostic model that uses automated brain scans and machine learning to inform outcomes in patients with severe traumatic brain injuries (TBI). Their findings are published in the journal Radiology, in a paper titled, "Outcome Prediction in Patients with Severe Traumatic Brain Injury Using Deep Learning from Head CT Scans." The researchers demonstrated that their advanced machine-learning algorithm can analyze brain scans and relevant clinical data from TBI patients to quickly and accurately predict survival and recovery six months after the injury. "Every day, in hospitals across the United States, care is withdrawn from patients who would have otherwise returned to independent living," said co-senior author David Okonkwo, MD, PhD, professor of neurological surgery at Pitt and UPMC. "The majority of people who survive a critical period in an acute care setting make a meaningful recovery--which further underscores the need to identify patients who are more likely to recover."

A paramedic gurney flies through the trauma bay carrying an unconscious elderly gentleman. He is already intubated and has a hive of doctors and nurses running alongside, placing intravenous lines and injecting medicine into his blood stream. He's suffered a serious head injury in a car accident. It was a cold winter afternoon in 2017, and the patient had been taken to a major regional hospital. When he arrived, the neurosurgeon on call had minutes to counsel the family on the man's prognosis, and together they needed to decide whether to operate; surgery could save the patient's life, but it could also commit him to a life dependent on a ventilator and a feeding tube, trapped in a coma or with limited brain function.