Prediction of ATLS hypovolemic shock class in rats using the perfusion index and lactate concentration

It is necessary to quickly and accurately determine Advanced Trauma Life Support (ATLS) hemorrhagic shock class for triage in cases of acute hemorrhage caused by trauma. However, the ATLS classification has limitations, namely, with regard to primary vital signs. This study identified the optimal variables for appropriate triage of hemorrhage severity, including the peripheral perfusion index and serum lactate concentration in addition to the conventional primary vital signs. To predict the four ATLS classes, three popular machine learning algorithms with four feature selection methods for multicategory classification were applied to a rat model of acute hemorrhage. A total of 78 anesthetized rats were divided into four groups for ATLS classification based on blood loss (in percent). The support vector machine one-versus-one model with the Kruskal-Wallis feature selection method performed best, with 80.8% accuracy, relative classifier information of 0.629, and a kappa index of 0.732. The new hemorrhage-induced severity index (lactate concentration/perfusion index), diastolic blood pressure, mean arterial pressure, and the perfusion index were selected as the optimal variables for predicting the four ATLS classes by support vector machine one-versus-one with the Kruskal-Wallis method. These four variables were also selected for binary classification to predict ATLS classes I and II versus III and IV for blood transfusion requirement. The suggested ATLS classification system would be helpful to first responders by indicating the severity of patients, allowing physicians to prepare suitable resuscitation before hospital arrival, which could hasten treatment initiation.