Classification of Traumatic Brain Injury Severity Using Informed Data Reduction in a Series of Binary Classifier Algorithms

• Published in: IEEE transactions on neural systems and rehabilitation engineering Vol. 20; no. 6; pp. 806 - 822
• Main Authors: Prichep, Leslie S., Jacquin, Arnaud, Filipenko, Julie, Dastidar, Samanwoy Ghosh, Zabele, Stephen, Vodencarevic, Asmir, Rothman, Neil S.
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.11.2012; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aging - physiology; Algorithms; Artificial Intelligence; Brain injuries; Brain Injuries - classification; Brain Injuries - diagnosis; Classification algorithms; Data Interpretation, Statistical; Electroencephalography; Eye Movements - physiology; Female; Fractals; Genetic algorithms (GAs); Glasgow Coma Scale; Head; Humans; Information Theory; informed data reduction; Linear Models; Male; Middle Aged; multiclass classification; Multivariate Analysis; Muscle, Skeletal - physiology; quantitative electroencephalography (QEEG); Reproducibility of Results; ROC Curve; Studies; Tomography, X-Ray Computed; traumatic brain injury (TBI); Young Adult
• ISSN: 1534-4320; 1558-0210; 1558-0210
• DOI: 10.1109/TNSRE.2012.2206609

Assessment of medical disorders is often aided by objective diagnostic tests which can lead to early intervention and appropriate treatment. In the case of brain dysfunction caused by head injury, there is an urgent need for quantitative evaluation methods to aid in acute triage of those subjects who have sustained traumatic brain injury (TBI). Current clinical tools to detect mild TBI (mTBI/concussion) are limited to subjective reports of symptoms and short neurocognitive batteries, offering little objective evidence for clinical decisions; or computed tomography (CT) scans, with radiation-risk, that are most often negative in mTBI. This paper describes a novel methodology for the development of algorithms to provide multi-class classification in a substantial population of brain injured subjects, across a broad age range and representative subpopulations. The method is based on age-regressed quantitative features (linear and nonlinear) extracted from brain electrical activity recorded from a limited montage of scalp electrodes. These features are used as input to a unique "informed data reduction" method, maximizing confidence of prospective validation and minimizing over-fitting. A training set for supervised learning was used, including: "normal control," "concussed," and "structural injury/CT positive (CT+)." The classifier function separating CT+ from the other groups demonstrated a sensitivity of 96% and specificity of 78%; the classifier separating "normal controls" from the other groups demonstrated a sensitivity of 81% and specificity of 74%, suggesting high utility of such classifiers in acute clinical settings. The use of a sequence of classifiers where the desired risk can be stratified further supports clinical utility.