{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T03:15:22Z","timestamp":1771557322378,"version":"3.50.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["#1R01NR016941-01"],"award-info":[{"award-number":["#1R01NR016941-01"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Communicating Narrative Concerns Entered"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Pressure injuries are common and serious complications for hospitalized patients. The pressure injury rate is an important patient safety metric and an indicator of the quality of nursing care. Timely and accurate prediction of pressure injury risk can significantly facilitate early prevention and treatment and avoid adverse outcomes. While many pressure injury risk assessment tools exist, most were developed before there was access to large clinical datasets and advanced statistical methods, limiting their accuracy. In this paper, we describe the development of machine learning-based predictive models, using phenotypes derived from nurse-entered direct patient assessment data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We utilized rich electronic health record data, including full assessment records entered by nurses, from 5 different hospitals affiliated with a large integrated healthcare organization to develop machine learning-based prediction models for pressure injury. Five-fold cross-validation was conducted to evaluate model performance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Two pressure injury phenotypes were defined for model development: nonhospital acquired pressure injury (N\u2009=\u20094398) and hospital acquired pressure injury (N\u2009=\u20091767), representing 2 distinct clinical scenarios. A total of 28 clinical features were extracted and multiple machine learning predictive models were developed for both pressure injury phenotypes. The random forest model performed best and achieved an AUC of 0.92 and 0.94 in 2 test sets, respectively. The Glasgow coma scale, a nurse-entered level of consciousness measurement, was the most important feature for both groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This model accurately predicts pressure injury development and, if validated externally, may be helpful in widespread pressure injury prevention.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocaa336","type":"journal-article","created":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T04:34:06Z","timestamp":1609302846000},"page":"759-765","source":"Crossref","is-referenced-by-count":65,"title":["Predicting pressure injury using nursing assessment phenotypes and machine learning methods"],"prefix":"10.1093","volume":"28","author":[{"given":"Wenyu","family":"Song","sequence":"first","affiliation":[{"name":"Department of Medicine, Brigham & Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}]},{"given":"Min-Jeoung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham & Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}]},{"given":"Linying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Columbia University, New York, New York, USA"}]},{"given":"Wonkyung","family":"Jung","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Washington, Seattle, Washington, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0362-0670","authenticated-orcid":false,"given":"Jiyoun","family":"Song","sequence":"additional","affiliation":[{"name":"School of Nursing, Columbia University, New York, New York, USA"}]},{"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham & Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Mass General Brigham, Boston, Massachusetts, USA"}]},{"given":"Patricia C","family":"Dykes","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham & Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Mass General Brigham, Boston, Massachusetts, USA"}]}],"member":"286","published-online":{"date-parts":[[2021,2,1]]},"reference":[{"key":"2021031906040054100_ocaa336-B1","volume-title":"Prevention and Treatment of Pressure Ulcers: Quick Reference Guide","author":"Haesler","year":"2014","edition":"2nd ed."},{"issue":"4","key":"2021031906040054100_ocaa336-B2","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.jaad.2018.12.069","article-title":"Pressure ulcers: pathophysiology, epidemiology, risk factors, and presentation","volume":"81","author":"Mervis","year":"2019","journal-title":"J Am Acad Dermato"},{"issue":"6","key":"2021031906040054100_ocaa336-B3","doi-asserted-by":"crossref","first-page":"461","DOI":"10.4037\/ajcc2018525","article-title":"Predicting pressure injury in critical care patients: a machine-learning model","volume":"27","author":"Alderden","year":"2018","journal-title":"Am J Crit Care"},{"key":"2021031906040054100_ocaa336-B4","author":"Berlowitz","year":"2011"},{"issue":"3","key":"2021031906040054100_ocaa336-B5","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/iwj.13071","article-title":"The national cost of hospital-acquired pressure injuries in the United States","volume":"16","author":"Padula","year":"2019","journal-title":"Int Wound J"},{"issue":"11","key":"2021031906040054100_ocaa336-B6","first-page":"30","article-title":"Pressure ulcers in the United States' inpatient population from 2008 to 2012: results of a retrospective nationwide study","volume":"62","author":"Bauer","year":"2016","journal-title":"Ostomy Wound Manage"},{"issue":"3\u20134","key":"2021031906040054100_ocaa336-B7","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/j.1365-2702.2011.03915.x","article-title":"Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study","volume":"21","author":"Theisen","year":"2012","journal-title":"J Clin Nurs"},{"issue":"2","key":"2021031906040054100_ocaa336-B8","first-page":"10","article-title":"Patient safety: a call to action: a consensus statement from the National Quality Forum","volume":"3","author":"Kizer","year":"2001","journal-title":"MedGenMed"},{"key":"2021031906040054100_ocaa336-B9","year":"2019"},{"issue":"1","key":"2021031906040054100_ocaa336-B10","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/1472-6963-14-83","article-title":"Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care","volume":"14","author":"Stern","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2021031906040054100_ocaa336-B11","doi-asserted-by":"crossref","first-page":"410","DOI":"10.7326\/0003-4819-158-5-201303051-00008","article-title":"Preventing in-facility pressure ulcers as a patient safety strategy: a systematic review","volume":"158 (5_Part_2","author":"Sullivan","year":"2013","journal-title":"Ann Intern Med"},{"issue":"4","key":"2021031906040054100_ocaa336-B12","first-page":"108","article-title":"Reduction of hospital-acquired pressure injuries using a multidisciplinary team approach: a descriptive study","volume":"31","author":"Miller","year":"2019","journal-title":"Wounds"},{"key":"2021031906040054100_ocaa336-B13","year":"2017"},{"issue":"4","key":"2021031906040054100_ocaa336-B14","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/00006199-198707000-00002","article-title":"The Braden Scale for predicting pressure sore risk","volume":"36","author":"Bergstrom","year":"1987","journal-title":"Nurs Res"},{"key":"2021031906040054100_ocaa336-B15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ijnurstu.2018.08.005","article-title":"Evaluating the development and validation of empirically-derived prognostic models for pressure ulcer risk assessment: a systematic review","volume":"89","author":"Shi","year":"2019","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"2021031906040054100_ocaa336-B16","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ijnurstu.2014.08.002","article-title":"Exploring factors associated with pressure ulcers: a data mining approach","volume":"52","author":"Raju","year":"2015","journal-title":"Int J Nurs Stud"},{"issue":"6","key":"2021031906040054100_ocaa336-B17","doi-asserted-by":"crossref","first-page":"514","DOI":"10.4037\/ajcc2013991","article-title":"Predictive validity of the Braden scale for patients in intensive care units","volume":"22","author":"Hyun","year":"2013","journal-title":"Am J Crit Care"},{"issue":"2","key":"2021031906040054100_ocaa336-B18","first-page":"122","article-title":"Assessing predictive validity of pressure ulcer risk scales-a systematic review and meta-analysis","volume":"45","author":"Seong-Hi","year":"2016","journal-title":"Iran J Public Health"},{"issue":"1","key":"2021031906040054100_ocaa336-B19","doi-asserted-by":"crossref","DOI":"10.5334\/egems.307","article-title":"Predicting the incidence of pressure ulcers in the intensive care unit using machine learning","volume":"7","author":"Cramer","year":"2019","journal-title":"eGEMs"},{"key":"2021031906040054100_ocaa336-B20","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijnurstu.2017.03.012","article-title":"Risk factors for pressure injuries among critical care patients: a systematic review","volume":"71","author":"Alderden","year":"2017","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"2021031906040054100_ocaa336-B21","article-title":"Risk assessment tools for the prevention of pressure ulcers","author":"Moore","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"S2","key":"2021031906040054100_ocaa336-B22","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12911-017-0471-z","article-title":"Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks","volume":"17","author":"Kaewprag","year":"2017","journal-title":"BMC Med Inform Decis Mak"},{"issue":"7","key":"2021031906040054100_ocaa336-B23","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.ijnurstu.2012.11.019","article-title":"Patient risk factors for pressure ulcer development: systematic review","volume":"50","author":"Coleman","year":"2013","journal-title":"Int J Nurs Stud"},{"issue":"5","key":"2021031906040054100_ocaa336-B24","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/iwj.12004","article-title":"Low serum albumin level as an independent risk factor for the onset of pressure ulcers in intensive care unit patients","volume":"11","author":"Serra","year":"2014","journal-title":"Int Wound J"},{"key":"2021031906040054100_ocaa336-B25","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1097\/01.WON.0000270854.08299.7c","article-title":"Assessment of the nutritional risk for pressure ulcer development through Brasend scale","volume":"34 (Supplement","author":"Serpa","year":"2007","journal-title":"J Wound Ostomy Continence Nurs"},{"issue":"5","key":"2021031906040054100_ocaa336-B26","doi-asserted-by":"crossref","first-page":"364","DOI":"10.4037\/ajcc2011934","article-title":"Predictors of pressure ulcers in adult critical care patients","volume":"20","author":"Cox","year":"2011","journal-title":"Am J Crit Care"},{"issue":"3","key":"2021031906040054100_ocaa336-B27","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/WON.0000000000000523","article-title":"Pressure injury prevention: outcomes and challenges to use of resident monitoring technology in a nursing home","volume":"46","author":"Yap","year":"2019","journal-title":"J Wound Ostomy Continence Nurs"},{"issue":"6","key":"2021031906040054100_ocaa336-B28","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1111\/iwj.12521","article-title":"A wearable wound moisture sensor as an indicator for wound dressing change: an observational study of wound moisture and status","volume":"13","author":"Milne","year":"2016","journal-title":"Int Wound J"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/28\/4\/759\/36642068\/ocaa336.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/28\/4\/759\/36642068\/ocaa336.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T06:05:47Z","timestamp":1616133947000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/28\/4\/759\/6124802"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,1]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,2,1]]},"published-print":{"date-parts":[[2021,3,18]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocaa336","relation":{},"ISSN":["1527-974X"],"issn-type":[{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,1]]},"published":{"date-parts":[[2021,2,1]]}}}