Mixed-variable graphical modeling framework towards risk prediction of hospital-acquired pressure injury in spinal cord injury individuals

Abstract Developing machine learning (ML) methods for healthcare predictive modeling requires absolute explainability and transparency to build trust and accountability. Graphical models (GM) are key tools for this but face challenges like small sample sizes, mixed variables, and latent confounders. This paper presents a novel learning framework addressing these challenges by integrating latent variables using fast causal inference (FCI), accommodating mixed variables with predictive permutation conditional independence tests (PPCIT), and employing a systematic graphical embedding approach leveraging expert knowledge. This method ensures a transparent model structure and an explainable feature selection and modeling approach, achieving competitive prediction performance. For real-world validation, data of hospital-acquired pressure injuries (HAPI) among individuals with spinal cord injury (SCI) were used, where the approach achieved a balanced accuracy of 0.941 and an AUC of 0.983, outperforming most benchmarks. The PPCIT method also demonstrated superior accuracy and scalability over other benchmarks in causal discovery validation on synthetic datasets that closely resemble our real dataset. This holistic framework effectively addresses the challenges of mixed variables and explainable predictive modeling for disease onset, which is crucial for enabling transparency and interpretability in ML-based healthcare.