{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:11:56Z","timestamp":1790413916090,"version":"4.1.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Amputation is an irreversible, last-line treatment indicated for a multitude of medical problems. Delaying amputation in favor of limb-sparing treatment may lead to increased risk of morbidity and mortality. This systematic review aims to synthesize the literature on how ML is being applied to predict amputation as an outcome. OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. 1376 studies were screened; 15 articles were included. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6\u20130.94). In trauma patients, models had strong to excellent performance (AUC: 0.88\u20130.95). In patients who received amputation secondary to other etiologies (e.g.: burns and peripheral vascular disease), models had similar performance (AUC: 0.81\u20131.0). Many studies were found to have a high PROBAST risk of bias, most often due to small sample sizes. In conclusion, multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting.<\/jats:p>","DOI":"10.1371\/journal.pone.0293684","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T18:25:02Z","timestamp":1699381502000},"page":"e0293684","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Predicting amputation using machine learning: A systematic review"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0765-1263","authenticated-orcid":true,"given":"Patrick Fangping","family":"Yao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi David","family":"Diao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9961-7999","authenticated-orcid":true,"given":"Eric P.","family":"McMullen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlin","family":"Manka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celina","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"issue":"1","key":"pone.0293684.ref001","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ejvs.2020.03.018","article-title":"Trends in surgical indications for major lower limb amputation in the USA from 2000 to 2016","volume":"60","author":"CA Kalbaugh","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"5","key":"pone.0293684.ref002","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/00005373-199005000-00007","article-title":"Objective criteria accurately predict amputation following lower extremity trauma","volume":"30","author":"K Johansen","year":"1990","journal-title":"J Trauma"},{"issue":"1","key":"pone.0293684.ref003","doi-asserted-by":"crossref","first-page":"12559","DOI":"10.1038\/s41598-021-91954-1","article-title":"Quality of life, body image and self-esteem in patients with unilateral transtibial amputations","volume":"11","author":"N Sarroca","year":"2021","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0293684.ref004","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/0304-3959(85)90090-9","article-title":"Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain","volume":"21","author":"TS Jensen","year":"1985","journal-title":"Pain"},{"issue":"1","key":"pone.0293684.ref005","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4103\/0972-6748.196041","article-title":"Psychological effects of amputation: A review of studies from India","volume":"25","author":"A Sahu","year":"2016","journal-title":"Ind Psychiatry J"},{"issue":"4","key":"pone.0293684.ref006","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/S0950-821X(05)80265-8","article-title":"Quality of life following lower limb amputation for peripheral arterial disease","volume":"7","author":"JP Pell","year":"1993","journal-title":"Eur J Vasc Surg"},{"issue":"1","key":"pone.0293684.ref007","first-page":"69","article-title":"Amputation: preoperative psychological preparation","volume":"5","author":"DJ Butler","year":"1992","journal-title":"J Am Board Fam Pract"},{"issue":"5\u20136","key":"pone.0293684.ref008","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1093\/milmed\/usy271","article-title":"Association of specific lower extremity injuries with delayed amputation","volume":"184","author":"SL Eskridge","year":"2019","journal-title":"Mil Med"},{"issue":"8","key":"pone.0293684.ref009","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1097\/00005373-198808000-00023","article-title":"The medical and economic impact of severely injured lower extremities","volume":"28","author":"FJ Bondurant","year":"1988","journal-title":"J Trauma"},{"issue":"10","key":"pone.0293684.ref010","doi-asserted-by":"crossref","first-page":"e0204726","DOI":"10.1371\/journal.pone.0204726","article-title":"Pre-operative rehabilitation for dysvascular lower-limb amputee patients: A focus group study involving medical professionals","volume":"13","author":"R Dekker","year":"2018","journal-title":"PLoS One"},{"key":"pone.0293684.ref011","doi-asserted-by":"crossref","DOI":"10.20471\/acc.2021.60.04.13","article-title":"Predictive factors for successful prosthetic rehabilitation after vascular transtibial amputation","author":"S. 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