Evaluation of Machine Learning Techniques to Predict the Likelihood of Mental Health Conditions Following a First mTBI.

OBJECTIVE: Limited research has evaluated the utility of machine learning models and longitudinal data from electronic health records (EHR) to forecast mental health outcomes following a traumatic brain injury (TBI). The objective of this study is to assess various data science and machine learning techniques and determine their efficacy in forecasting mental health (MH) conditions among active duty Service Members (SMs) following a first diagnosis of mild traumatic brain injury (mTBI). MATERIALS AND METHODS: Patient demographics and encounter metadata of 35,451 active duty SMs who have sustained an initial mTBI, as documented within the EHR, were obtained. All encounter records from a year prior and post index mTBI date were collected. Patient demographics, ICD-9-CM and ICD-10 codes, enhanced diagnostic related groups, and other risk factors estimated from the year prior to index mTBI were utilized to develop a feature vector representative of each patient. To embed temporal information into the feature vector, various window configurations were devised. Finally, the presence or absence of mental health conditions post mTBI index date were used as the outcomes variable for the models. RESULTS: When evaluating the machine learning models, neural network techniques showed the best overall performance in identifying patients with new or persistent mental health conditions post mTBI. Various window configurations were tested and results show that dividing the observation window into three distinct date windows [-365:-30, -30:0, 0:14] provided the best performance. Overall, the models described in this paper identified the likelihood of developing MH conditions at [14:90] days post-mTBI with an accuracy of 88.2%, an AUC of 0.82, and AUC-PR of 0.66. DISCUSSION: Through the development and evaluation of different machine learning models we have validated the feasibility of designing algorithms to forecast the likelihood of developing mental health conditions after the first mTBI. Patient attributes including demographics, symptomatology, and other known risk factors proved to be effective features to employ when training ML models for mTBI patients. When patient attributes and features are estimated at different time window, the overall performance increase illustrating the importance of embedding temporal information into the models. The addition of temporal information not only improved model performance, but also increased interpretability and clinical utility. CONCLUSION: Predictive analytics can be a valuable tool for understanding the effects of mTBI, particularly when identifying those individuals at risk of negative outcomes. The translation of these models from retrospective study into real-world validation models is imperative in the mitigation of negative outcomes with appropriate and timely interventions.

A Grammar-based Approach for Modeling User Interactions and Generating Suggestions During the Data Exploration Process.

Despite the recent popularity of visual analytics focusing on big data, little is known about how to support users that use visualization techniques to explore multi-dimensional datasets and accomplish specific tasks. Our lack of models that can assist end-users during the data exploration process has made it challenging to learn from the user's interactive and analytical process. The ability to model how a user interacts with a specific visualization technique and what difficulties they face are paramount in supporting individuals with discovering new patterns within their complex datasets. This paper introduces the notion of visualization systems understanding and modeling user interactions with the intent of guiding a user through a task thereby enhancing visual data exploration. The challenges faced and the necessary future steps to take are discussed; and to provide a working example, a grammar-based model is presented that can learn from user interactions, determine the common patterns among a number of subjects using a K-Reversible algorithm, build a set of rules, and apply those rules in the form of suggestions to new users with the goal of guiding them along their visual analytic process. A formal evaluation study with 300 subjects was performed showing that our grammar-based model is effective at capturing the interactive process followed by users and that further research in this area has the potential to positively impact how users interact with a visualization system.

A K-Reversible Approach to Model Clinical Trajectories.

A clinical trajectory can be defined as the path followed by patients between an initial heath state Si such as being healthy to another state Sj such as being diagnosed with a specific clinical condition. Being able to identify the common trajectories that a group of patients take can benefit clinicians at identifying the current state of patient and potentially provide early treatment to avoid going towards specific paths. In this paper we present our approach that enables a clinical dataset of patient encounters to be clustered into groups of similarity and run through our algorithm which produces an automaton displaying the most common trajectories taken by patients. Furthermore, we explore a dataset of patients that have experienced mild traumatic brain injuries (mTBI) to show that our approach is effective at clustering and identifying common trajectories for patients that develop headaches, sleep, and post traumatic stress disorder (PTSD) post concussion.