• Nehemiah T Liu and Jose Salinas.
• US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas.
• Shock. 2017 Nov 1; 48 (5): 504-510.

AbstractTo date, there are no reviews on machine learning (ML) for predicting outcomes in trauma. Consequently, it remains unclear as to how ML-based prediction models compare in the triage and assessment of trauma patients. The objective of this review was to survey and identify studies involving ML for predicting outcomes in trauma, with the hypothesis that models predicting similar outcomes may share common features but the performance of ML in these studies will differ greatly. MEDLINE and other databases were searched for studies involving trauma and ML. Sixty-five observational studies involving ML for the prediction of trauma outcomes met inclusion criteria. In total 2,433,180 patients were included in the studies. The studies focused on prediction of the following outcome measures: survival/mortality (n = 34), morbidity/shock/hemorrhage (n = 12), hospital length of stay (n = 7), hospital admission/triage (n = 6), traumatic brain injury (n = 4), life-saving interventions (n = 5), post-traumatic stress disorder (n = 4), and transfusion (n = 1). Six studies were prospective observational studies. Of the 65 studies, 33 used artificial neural networks for prediction. Importantly, most studies demonstrated the benefits of ML models. However, algorithm performance was assessed differently by different authors. Sensitivity-specificity gap values varied greatly from 0.035 to 0.927. Notably, studies shared many features for model development. A common ML feature base may be determined for predicting outcomes in trauma. However, the impact of ML will require further validation in prospective observational studies and randomized clinical trials, establishment of common performance criteria, and high-quality evidence about clinical and economic impacts before ML can be widely accepted in practice.

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