Augmenting decision making in acute care surgery: A systematic review of machine learning–driven risk prediction models
Bibliographic record
Abstract
BACKGROUND: Acute care surgery (ACS) involves rapid, high-stakes decisions with limited opportunity for preoperative planning. While machine learning (ML) may improve risk prediction and decision making in this setting, its development, validation, and implementation in ACS remain understudied. We therefore evaluated the techniques, predictor features, and outcomes used in ML-driven risk prediction models in ACS and generated recommendations to inform future research and support clinically meaningful implementation. METHODS: A systematic review of ML-driven predictive models in ACS (emergency general surgery, surgical critical care, trauma) was conducted. Models were analyzed by predictor features, outcomes, algorithms, and performance. The best-performing models for the most commonly predicted outcome were identified. RESULTS: Of 52 studies, 57.7% focused on trauma populations. Most models used registry data (76.8%), fewer used electronic health records (28.8%), and only five studies performed external validation after model development. Common algorithms included logistic regression (44.2%), random forest (34.6%), and decision trees (26.9%). Mortality (59.6%), complications (30.8%), and triage/severity (15.4%) were the most frequent outcomes; patient-centered/reported outcomes were absent. Features commonly included demographics, physiologic scores, and vital signs, while imaging and intraoperative data were underused. Natural language processing was used in four studies. Model performance was typically assessed using area under the receiver operating characteristic curve (88.5%), with support vector machines demonstrating the highest performance. Machine learning models generally outperformed conventional risk scores among 11 comparative studies. CONCLUSION: Machine learning-driven predictive models in ACS show promising performance but are constrained by limited methodological rigor, real-world validation, and substantial heterogeneity in features, outcomes, and algorithms, challenging systematic adoption and oversight. A grounded understanding of ACS decision making workflows and their postimplementation impact may ensure clinically relevant, seamless, and safe integration of ML-based risk prediction. LEVEL OF EVIDENCE: Systematic Review Without Meta-analysis; Level IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.106 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.012 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".