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Statistical learning of blunt cerebrovascular injury risk factors using the elastic net

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Abstract

Purpose

To compare logistic regression to elastic net for identifying and ranking clinical risk factors for blunt cerebrovascular injury (BCVI).

Materials and methods

Consecutive trauma patients undergoing screening CTA at a level 1 trauma center over a 2-year period. Each internal carotid artery (ICA) and vertebral artery (VA) was independently graded by 2 neuroradiologists using the Denver grading scale. Unadjusted odds ratios were calculated by univariate and adjusted odds ratios by multiple logistic regression with FDR correction. We applied logistic regression with the elastic net penalty and tenfold cross-validation.

Results

Total of 467 patients; 73 patients with BCVI. Maxillofacial fracture, basilar skull fracture, and GCS had significant unadjusted odds ratios (OR) for ICA injury and C-spine fracture, spinal ligamentous injury, and age for VA injury. Only transverse foramen fracture had significant adjusted OR for VA injury, with none for ICA injury, after FDR correction. Using elastic net, ICA injury variables included maxillofacial fracture, basilar skull fracture, GCS, and carotid canal fracture. For VA injury, these included cervical spine transverse foramen fracture, ligamentous injury, C1–C3 fractures, posterior element fracture, and vertebral body fracture.

Conclusion

Elastic net statistical learning methods identified additional risk factors and outperformed multiple logistic regression for BCVI. Elastic net allows the study of a large number of variables, and is useful when covariates are correlated.

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Author information

Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Suite BG20, GA, Atlanta, 30222, USA

    Maxwell E. Cooper, Amanda Corey, Arthur J. Fountain & Jason W. Allen

  2. Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Benjamin Risk

  3. Department of Radiology, Atlanta Veterans Affairs Healthcare System, Atlanta, GA, USA

    Amanda Corey

  4. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Jason W. Allen

Authors
  1. Maxwell E. Cooper
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  2. Benjamin Risk
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  3. Amanda Corey
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  4. Arthur J. Fountain
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  5. Jason W. Allen
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Contributions

Jason Allen, Arthur Fountain, and Amanda Corey conceived and designed the study and collected the data. Data analysis was performed by all authors. The first draft of the manuscript was written by Maxwell Cooper and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason W. Allen.

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The protocol for this study was reviewed by the Institutional Review Board at our institution.

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The authors declare that they have no conflict of interest.

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Cooper, M.E., Risk, B., Corey, A. et al. Statistical learning of blunt cerebrovascular injury risk factors using the elastic net. Emerg Radiol 28, 929–937 (2021). https://doi.org/10.1007/s10140-021-01949-8

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  • DOI: https://doi.org/10.1007/s10140-021-01949-8

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