title: Development of a Bayesian model to estimate health care outcomes in the severely wounded.
abstract: BACKGROUND
  Graphical probabilistic models have the ability to provide insights as to how clinical factors are conditionally related. These models can be used to help us understand factors influencing health care outcomes and resource utilization, and to estimate morbidity and clinical outcomes in trauma patient populations.
  
  
  METHODS
  Thirty-two combat casualties with severe extremity injuries enrolled in a prospective observational study were analyzed using step-wise machine-learned Bayesian belief network (BBN) and step-wise logistic regression (LR). Models were evaluated using 10-fold cross-validation to calculate area-under-the-curve (AUC) from receiver operating characteristics (ROC) curves.
  
  
  RESULTS
  Our BBN showed important associations between various factors in our data set that could not be developed using standard regression methods. Cross-validated ROC curve analysis showed that our BBN model was a robust representation of our data domain and that LR models trained on these findings were also robust: hospital-acquired infection (AUC: LR, 0.81; BBN, 0.79), intensive care unit length of stay (AUC: LR, 0.97; BBN, 0.81), and wound healing (AUC: LR, 0.91; BBN, 0.72) showed strong AUC.
  
  
  CONCLUSIONS
  A BBN model can effectively represent clinical outcomes and biomarkers in patients hospitalized after severe wounding, and is confirmed by 10-fold cross-validation and further confirmed through logistic regression modeling. The method warrants further development and independent validation in other, more diverse patient populations.
authors.affiliation: Combat Wound Initiative Program.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: John
authors.initials: J
authors.lastname: Eberhardt
authors.forename: Trevor S
authors.initials: TS
authors.lastname: Brown
authors.forename: Jason S
authors.initials: JS
authors.lastname: Hawksworth
authors.forename: Frederick
authors.initials: F
authors.lastname: Gage
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Tadaki
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Davis
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
authors.forename: James R
authors.initials: JR
authors.lastname: Dunne
authors.forename: E A
authors.initials: EA
authors.lastname: Elster