Prediction and Stage Classification of Pressure Ulcers in Intensive Care Patients by Machine Learning.

Abstract

Background/Objective: Pressure ulcers are a serious clinical problem associated with high morbidity, mortality and healthcare costs, especially in intensive care unit (ICU) patients. Existing risk assessment tools, such as the Braden Score, are often inadequate in ICU patients and have poor discriminatory power between classes. This increases the need for more sensitive, predictive and integrative systems. The aim of this study was to classify pressure ulcer stages (Stages I-IV) with high accuracy using machine learning algorithms using demographic, clinical and laboratory data of ICU patients and to evaluate the model performance at a level that can be integrated into clinical decision support systems. Methods: A total of 200 patients hospitalized in the ICU were included in the study. Using demographic, clinical and laboratory data of the patients, six different machine learning algorithms (SVM, KNN, ANN, Decision Tree, Naive Bayes and Discriminant Analysis) were used for classification. The models were evaluated using confusion matrices, ROC-AUC analyses and metrics such as class-based sensitivity and error rate. Results: SVM, KNN and ANN models showed the highest success in classifying pressure ulcer stages, achieving 99% overall accuracy and excellent performance with AUC = 1.00. Variables such as Braden score, albumin and CRP levels contributed significantly to model performance. ROC curves showed that the models provided strong discrimination between classes. Key predictors of pressure ulcer severity included prolonged ICU stay (p < 0.001), low albumin (Stage I: 3.4 ± 0.5 g/dL vs. Stage IV: 2.4 ± 0.8 g/dL; p < 0.001) and high CRP (Stage I: 28 mg/L vs. Stage IV: 142 mg/L; p < 0.001). Conclusions: This study shows that machine learning algorithms offer high accuracy and generalization potential in pressure ulcer classification. In particular, the effectiveness of algorithms such as SVM, ANN and KNN in detecting early-stage ulcers is promising in terms of integration into clinical decision support systems. In future studies, the clinical validity of the model should be increased with multicenter datasets and visual-data-based hybrid models.