Table 1_Explainable machine learning-based prediction of early and mid-term postoperative complications in adolescent tibial fractures.docx
Background<p>Adolescent tibial fractures commonly lead to postoperative complications. Conventional coagulation markers (PT/APTT/FIB) lack combinatorial risk assessment. We developed an explainable ML model integrating coagulation and clinical features to predict adverse events.</p>Metho...
محفوظ في:
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| مؤلفون آخرون: | , , , |
| منشور في: |
2025
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| الموضوعات: | |
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إضافة وسم
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| الملخص: | Background<p>Adolescent tibial fractures commonly lead to postoperative complications. Conventional coagulation markers (PT/APTT/FIB) lack combinatorial risk assessment. We developed an explainable ML model integrating coagulation and clinical features to predict adverse events.</p>Methods<p>A retrospective cohort of 624 surgical patients (13–18 years) was analyzed. AutoML with Improved Harmony Search Optimization (IHSO) processed features: age, fracture classification, surgery duration, blood loss, and 24 h-postoperative labs (coagulation triad/D-dimer/CRP). Primary outcome: 90-day composite adverse events (DVT/infection/early callus formation disorder/reoperation). SHAP explained predictions.</p>Results<p>Baseline characteristics were balanced between training and test sets (P > 0.05). The IHSO-optimized algorithm outperformed controls in 91.67% of CEC2022 benchmark functions. AutoML model performance significantly surpassed conventional methods: training set ROC-AUC: 0.9667, test set ROC-AUC: 0.9247 (PR-AUC: 0.8350). Decision curves demonstrated clinical net benefit across 6%–99% risk thresholds. Key feature importance ranked as: age > operative duration > fibrinogen > fracture classification > APTT > CRP > BMI > D-dimer. SHAP analysis revealed: 1) Increasing age significantly attenuates the risk contribution of surgery duration; 2) FIB >4.0 g/L + elevated CRP indicated coagulation-inflammation cascade; 3) AO-C type fractures carried highest risk.</p>Conclusion<p>This AutoML model, validated through explainability techniques, confirms the core predictive value of age, operative duration, and coagulation-inflammation networks for adolescent tibial fracture risk management. Though requiring prospective validation, the three-tier warning system establishes a stepped framework for individualized intervention. Future studies should advance multicenter collaborations integrating dynamic monitoring indicators to optimize clinical applicability.</p> |
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