Integrated Machine Learning Approach for the Early Prediction of Pressure Ulcers in Spinal Cord Injury Patients.

(1) Background: Pressure ulcers (PUs) substantially impact the quality of life of spinal cord injury (SCI) patients and require prompt intervention. This study used machine learning (ML) techniques to develop advanced predictive models for the occurrence of PUs in patients with SCI. (2) Methods: By analyzing the medical records of 539 patients with SCI, we observed a 35% incidence of PUs during hospitalization. Our analysis included 139 variables, including baseline characteristics, neurological status (International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI]), functional ability (Korean version of the Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]), and laboratory data. We used a variety of ML methods-a graph neural network (GNN), a deep neural network (DNN), a linear support vector machine (SVM_linear), a support vector machine with radial basis function kernel (SVM_RBF), K-nearest neighbors (KNN), a random forest (RF), and logistic regression (LR)-focusing on an integrative analysis of laboratory, neurological, and functional data. (3) Results: The SVM_linear algorithm using these composite data showed superior predictive ability (area under the receiver operating characteristic curve (AUC) = 0.904, accuracy = 0.944), as demonstrated by a 5-fold cross-validation. The critical discriminators of PU development were identified based on limb functional status and laboratory markers of inflammation. External validation highlighted the challenges of model generalization and provided a direction for future research. (4) Conclusions: Our study highlights the importance of a comprehensive, multidimensional data approach for the effective prediction of PUs in patients with SCI, especially in the acute and subacute phases. The proposed ML models show potential for the early detection and prevention of PUs, thus contributing substantially to improving patient care in clinical settings.