Methodological choices influence machine learning performance for predicting intracranial hypertension in traumatic brain injury
Abstract
Intracranial hypertension (IH) is a major cause of secondary brain injury after traumatic brain injury (TBI) and is typically treated after onset. Machine learning (ML) approaches show promise for IH prediction, but methodological heterogeneity across studies limits comparability and clinical translation. We evaluated how key methodological choices influence ML performance for IH prediction. In this retrospective observational study, intracranial pressure (ICP), arterial blood pressure (ABP), and additional variables were collected from TBI patients in two Dutch hospitals and the CENTER-TBI high-resolution cohort. Six methodological categories were varied: IH definition (ICP ≥ 22 or ≥ 30 mmHg), input data configuration, labelling strategy (IH onset versus continuous labelling), temporal separation of control segments, observation window length (10–600 min), and model class (eXtreme Gradient Boosting, random forest, logistic regression, Gaussian naïve Bayes, and long short-term memory). Models were evaluated using patient-level tenfold cross-validation with area under the receiver operating characteristic curve (AUC) as primary outcome. We included 316 patients. Prediction performance varied substantially across methodological choices. Continuous labelling inflated performance, and optimal observation windows were 240–360 min. Across conditions, eXtreme Gradient Boosting achieved the highest performance (AUC 0.92). These findings highlight the need for standardized methodology and transparent reporting in IH prediction studies.
Authors 45
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C. R. van Kaam corresponding
Radboud University Medical Center
Affiliation as printed
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Johannes Kepler University of Linz · Kepler Universitätsklinikum
Affiliation as printed
Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
Neurology, Clinical Research Institute of Neuroscience, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
School for Mental Health and Neuroscience, University Maastricht, Maastricht, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Radboud University Nijmegen · Donders Institute for Brain, Cognition and Behaviour
Affiliation as printed
Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Radboud University Nijmegen · Donders Institute for Brain, Cognition and Behaviour
Affiliation as printed
Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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University Hospital of North Norway
Affiliation as printed
Department of Physical Medicine and Rehabilitation, University Hospital Northern Norway, Tromsø, Norway
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
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Karolinska University Hospital
Affiliation as printed
Department of Neurosurgery & Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
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Affiliation as printed
Department of Neurosurgery, University of Pécs and MTA-PTE Clinical Neuroscience MR Research Group and János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Affiliation as printed
NeuroIntensive Care, Niguarda Hospital, Milan, Italy
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Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Affiliation as printed
NeuroIntensive Care, Niguarda Hospital, Milan, Italy
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Azienda Ospedaliera San Gerardo · University of Milano-Bicocca
Affiliation as printed
NeuroIntensive Care Unit, Department of Anesthesia & Intensive Care, ASST Di Monza, Monza, Italy
School of Medicine and Surgery, Università Milano Bicocca, Milan, Italy
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Affiliation as printed
Department of Neurosurgery, University of Pécs and MTA-PTE Clinical Neuroscience MR Research Group and János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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University Hospital of North Norway
Affiliation as printed
Department of Anesthesiology and Intensive Care, University Hospital Northern Norway, Tromsø, Norway
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
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Sheffield Teaching Hospitals NHS Foundation Trust
Affiliation as printed
Neurointensive Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Affiliation as printed
Departments of Neurology, Clinical Neurophysiology and Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
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University Hospital of Umeå · Umeå University
Affiliation as printed
Department of Clinical Neuroscience, Neurosurgery, Umeå University Hospital, Umeå, Sweden
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Universitair Ziekenhuis Leuven
Affiliation as printed
Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
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Affiliation as printed
Department of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
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Karolinska University Hospital
Affiliation as printed
Department of Neurosurgery & Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
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Affiliation as printed
Helsinki University Hospital, Helsinki, Finland
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Vall d'Hebron Hospital Universitari
Affiliation as printed
Department of Neurosurgery, Vall d’Hebron University Hospital, Barcelona, Spain
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Kaunas University of Technology · Vilnius University
Affiliation as printed
Department of Neurosurgery, Kaunas University of Technology and Vilnius University, Vilnius, Lithuania
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NHS Lothian · University of Edinburgh
Affiliation as printed
Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian and University of Edinburgh, Edinburgh, UK
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NHS Lothian · University of Edinburgh
Affiliation as printed
Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian and University of Edinburgh, Edinburgh, UK
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Kaunas University of Technology · Vilnius University
Affiliation as printed
Department of Neurosurgery, Kaunas University of Technology and Vilnius University, Vilnius, Lithuania
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Affiliation as printed
Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
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Vall d'Hebron Hospital Universitari
Affiliation as printed
Department of Neurosurgery, Vall d’Hebron University Hospital, Barcelona, Spain
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University Hospital Heidelberg · Klinikum Ludwigsburg
Affiliation as printed
Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
Klinik Für Neurochirurgie, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Affiliation as printed
Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
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University Hospital of Umeå · Umeå University
Affiliation as printed
Department of Radiation Sciences, Biomedical Engineering, Umeå University Hospital, Umeå, Sweden
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University of Turku · Turku University Hospital
Affiliation as printed
Intensive Care Medicine and Pain Management, Perioperative Services, Turku University Central Hospital and University of Turku, Turku, Finland
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Lithuanian University of Health Sciences
Affiliation as printed
Neuro-Intensive Care Unit, Kaunas University of Health Sciences, Kaunas, Lithuania
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University of Turku · Turku University Hospital
Affiliation as printed
Rehabilitation and Brain Trauma, Turku University Central Hospital and University of Turku, Turku, Finland
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Neurologie, Neurochirurgie Und Psychiatrie, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Azienda Ospedaliera San Gerardo
Affiliation as printed
NeuroIntensive Care Unit, Department of Anesthesia & Intensive Care, ASST Di Monza, Monza, Italy
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Lithuanian University of Health Sciences
Affiliation as printed
Neuro-Intensive Care Unit, Kaunas University of Health Sciences, Kaunas, Lithuania
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Interdisciplinary Neuro Intensive Care Unit, Charité Universitätsmedizin Berlin, Berlin, Germany
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University Hospital Heidelberg
Affiliation as printed
Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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