Machine Learning Reveals Demographic Disparities in Palliative Care Timing Among Patients With Traumatic Brain Injury Receiving Neurosurgical Consultation

• Published in: Neurocritical care 2024-12
• Main Authors: Aude, Carlos A, Vattipally, Vikas N, Das, Oishika, Ran, Kathleen R, Giwa, Ganiat A, Rincon-Torroella, Jordina, Xu, Risheng, Byrne, James P, Muehlschlegel, Susanne, Suarez, Jose I, Mukherjee, Debraj, Huang, Judy, Azad, Tej D, Bettegowda, Chetan
• Format: Article
• Language: English
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-024-02172-2

Timely palliative care (PC) consultations offer demonstrable benefits for patients with traumatic brain injury (TBI), yet their implementation remains inconsistent. This study employs machine learning methods to identify distinct patient phenotypes and elucidate the primary drivers of PC consultation timing variability in TBI management, aiming to uncover disparities and inform more equitable care strategies. Data on admission, hospital course, and outcomes were collected for a cohort of 232 patients with TBI who received both PC consultations and neurosurgical consultations during the same hospitalization. Patient phenotypes were uncovered using principal component analysis and K-means clustering; time-to-PC consultation for each phenotype was subsequently compared by Kaplan-Meier analysis. An extreme gradient boosting model with Shapley Additive Explanations identified key factors influencing PC consultation timing. Three distinct patient clusters emerged: cluster A (n = 86), comprising older adult White women (median 87 years) with mild TBI, received the earliest PC consultations (median 2.5 days); cluster B (n = 108), older adult White men (median 81 years) with mild TBI, experienced delayed PC consultations (median 5.0 days); and cluster C (n = 38), middle-aged (median: 46.5 years), severely injured, non-White patients, had the latest PC consultations (median 9.0 days). The clusters did not differ by discharge disposition (p = 0.4) or inpatient mortality (p > 0.9); however, Kaplan-Meier analysis revealed a significant difference in time-to-PC consultation (p