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Gao J, Chen G, O'Rourke AP, Caskey J, Carey KA, Oguss M, Stey A, Dligach D, Miller T, Mayampurath A, Churpek MM, Afshar M. Automated stratification of trauma injury severity across multiple body regions using multi-modal, multi-class machine learning models. J Am Med Inform Assoc 2024; 31:1291-1302. [PMID: 38587875 DOI: 10.1093/jamia/ocae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE The timely stratification of trauma injury severity can enhance the quality of trauma care but it requires intense manual annotation from certified trauma coders. The objective of this study is to develop machine learning models for the stratification of trauma injury severity across various body regions using clinical text and structured electronic health records (EHRs) data. MATERIALS AND METHODS Our study utilized clinical documents and structured EHR variables linked with the trauma registry data to create 2 machine learning models with different approaches to representing text. The first one fuses concept unique identifiers (CUIs) extracted from free text with structured EHR variables, while the second one integrates free text with structured EHR variables. Temporal validation was undertaken to ensure the models' temporal generalizability. Additionally, analyses to assess the variable importance were conducted. RESULTS Both models demonstrated impressive performance in categorizing leg injuries, achieving high accuracy with macro-F1 scores of over 0.8. Additionally, they showed considerable accuracy, with macro-F1 scores exceeding or near 0.7, in assessing injuries in the areas of the chest and head. We showed in our variable importance analysis that the most important features in the model have strong face validity in determining clinically relevant trauma injuries. DISCUSSION The CUI-based model achieves comparable performance, if not higher, compared to the free-text-based model, with reduced complexity. Furthermore, integrating structured EHR data improves performance, particularly when the text modalities are insufficiently indicative. CONCLUSIONS Our multi-modal, multiclass models can provide accurate stratification of trauma injury severity and clinically relevant interpretations.
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Affiliation(s)
- Jifan Gao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - John Caskey
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Kyle A Carey
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Madeline Oguss
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Anne Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Center of Health Services and Outcomes Research, Institute for Public Health and Medicine, Chicago, IL 60611, United States
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL 60660, United States
| | - Timothy Miller
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Anoop Mayampurath
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Matthew M Churpek
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Majid Afshar
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
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Oliveira GDF, Nguyen AT, Carreras-Simons L, Niepsuj T, Gadelhak SH, Johnson AK, Abdalla A, Lev E, Torres Román SG, Fuchs SN, Jorgensen JS, Farhat WA, Auger AP. Puberty Blocker, Leuprolide, Reduces Sex Differences in Rough-and-Tumble Play and Anxiety-like Behavior in Juvenile Rats. Endocrinology 2024; 165:bqae046. [PMID: 38597659 PMCID: PMC11033216 DOI: 10.1210/endocr/bqae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024]
Abstract
We examined the effect of the puberty blocker, leuprolide acetate, on sex differences in juvenile rough-and-tumble play behavior and anxiety-like behavior in adolescent male and female rats. We also evaluated leuprolide treatment on gonadal and pituitary hormone levels and activity-regulated cytoskeleton-protein messenger RNA levels within the adolescent amygdala, a region important both for rough-and-tumble play and anxiety-like behavior. Our findings suggest that leuprolide treatment lowered anxiety-like behavior during adolescent development, suggesting that the maturation of gonadotropin-releasing hormone systems may be linked to increased anxiety. These data provide a potential new model to understand the emergence of increased anxiety triggered around puberty. Leuprolide also reduced masculinized levels of rough-and-tumble play behavior, lowered follicle-stimulating hormone, and produced a consistent pattern of reducing or halting sex differences of hormone levels, including testosterone, growth hormone, thyrotropin, and corticosterone levels. Therefore, leuprolide treatment not only pauses sexual development of peripheral tissues, but also reduces sex differences in hormones, brain, and behavior, allowing for better harmonization of these systems following gender-affirming hormone treatment. These data contribute to the intended use of puberty blockers in stopping sex differences from developing further with the potential benefit of lowering anxiety-like behavior.
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Affiliation(s)
- Gabriela de Faria Oliveira
- Wisconsin National Primate Research Center, Madison, WI 53715, USA
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Amber T Nguyen
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | | | - Thomas Niepsuj
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Salma H Gadelhak
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Aimee K Johnson
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Ashwakh Abdalla
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Eden Lev
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Sofia G Torres Román
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Samantha N Fuchs
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Joan S Jorgensen
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Walid A Farhat
- Division of Pediatric Urology, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI 53705, USA
| | - Anthony P Auger
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706, USA
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