Predictive Modeling of Long-Term Care Needs in Traumatic Brain Injury Patients Using Machine Learning

Traumatic brain injury (TBI) research often focuses on mortality rates or functional recovery, yet the critical need for long-term care among patients dependent on institutional or Respiratory Care Ward (RCW) support remains underexplored. This study aims to address this gap by employing machine learning techniques to develop and validate predictive models that analyze the prognosis of this patient population.

Retrospective data from electronic medical records at Chi Mei Medical Center, encompassing 2020 TBI patients admitted to the ICU between January 2016 and December 2021, were collected. A total of 44 features were included, utilizing four machine learning models and various feature combinations based on clinical significance and Spearman correlation coefficients. Predictive performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and validated with the DeLong test and SHAP (SHapley Additive exPlanations) analysis.

Notably, 236 patients (11.68%) were transferred to long-term care centers. XGBoost with 27 features achieved the highest AUC (0.823), followed by Random Forest with 11 features (0.817), and LightGBM with 44 features (0.813). The DeLong test revealed no significant differences among the best predictive models under various feature combinations. SHAP analysis illustrated a similar distribution of feature importance for the top 11 features in XGBoost, with 27 features, and Random Forest with 11 features.

Random Forest, with an 11-feature combination, provided clinically meaningful predictive capability, offering early insights into long-term care trends for TBI patients. This model supports proactive planning for institutional or RCW resources, addressing a critical yet often overlooked aspect of TBI care.