A risk prediction model for venous thromboembolism in hospitalized patients with thoracic trauma: a machine learning, national multicenter retrospective study

Abstract

Early treatment and prevention are the keys to reducing the mortality of VTE in patients with thoracic trauma. This study aimed to develop and validate an automatic prediction model based on machine learning for VTE risk screening in patients with thoracic trauma. In this national multicenter retrospective study, the clinical data of chest trauma patients hospitalized in 33 hospitals in China from October 2020 to September 2021 were collected for model training and testing. The data of patients with thoracic trauma at Shanghai Sixth People’s Hospital from October 2021 to September 2022 were included for further verification. The performance of the model was measured mainly by the area under the receiver operating characteristic curve (AUROC) and the mean accuracy (mAP), and the sensitivity, specificity, positive predictive value, and negative predictive value were also measured. A total of 3116 patients were included in the training and validation of the model. External validation was performed in 408 patients. The random forest (RF) model was selected as the final model, with an AUROC of 0·879 (95% CI 0·856–0·902) in the test dataset. In the external validation, the AUROC was 0.83 (95% CI 0.794–0.866), the specificity was 0.756 (95% CI 0.713–0.799), the sensitivity was 0.821 (95% CI 0.692–0.923), the negative predictive value was 0.976 (95% CI 0.958–0.993), and the positive likelihood ratio was 3.364. This model can be used to quickly screen for the risk of VTE in patients with thoracic trauma. More than 90% of unnecessary VTE tests can be avoided, which can help clinicians target interventions to high-risk groups and ensure resource optimization. Although further validation and improvement are needed, this study has considerable clinical value.