Background Hospital-acquired pressure injuries (PIs) induce significant patient suffering, inflate healthcare costs, and increase clinical co-morbidities. PIs are mostly due to bed-immobility, sensory impairment, bed positioning, and length of hospital stay. In this study, we use electronic health records and administrative data to examine the contributing factors to PI development using artificial intelligence (AI). Methods We used advanced data science techniques to first preprocess the data and then train machine learning classifiers to predict the probability of developing PIs. The AI training was based on large, incongruent, incomplete, heterogeneous, and time-varying data of hospitalized patients. Both model-based statistical methods and model-free AI strategies were used to forecast PI outcomes and determine the salient features that are highly predictive of the outcomes. Results Our findings reveal that PI prediction by model-free techniques outperform model-based forecasts. The performance of all AI methods is improved by rebalancing the training data and by including the Braden in the model learning phase. Compared to neural networks and linear modeling, with and without rebalancing or using Braden scores, Random forest consistently generated the optimal PI forecasts. Conclusions AI techniques show promise to automatically identify patients at risk for hospital acquired PIs in different surgical services. Our PI prediction model provide a first generation of AI guidance to prescreen patients at risk for developing PIs. Clinical impact This study provides a foundation for designing, implementing, and assessing novel interventions addressing specific healthcare needs. Specifically, this approach allows examining the impact of various dynamic, personalized, and clinical-environment effects on PI prevention for hospital patients receiving care from various surgical services.

Many modern techniques for analyzing time-varying longitudinal data rely on parametric models to interrogate the timecourses of univariate or multivariate processes. Typical analytic objectives include utilizing retrospective observations to model current trends, predict prospective trajectories, derive categorical traits, or characterize various relations. Among the many mathematical, statistical, and computational strategies for analyzing longitudinal data, tensor-based linear modeling offers a unique algebraic approach that encodes different characterizations of the observed measurements in terms of state indices. This paper introduces a new method of representing, modeling, and analyzing repeated-measurement longitudinal data using a generalization of event order from the positive reals to the complex plane. Using complex time (kime), we transform classical time-varying signals as 2D manifolds called kimesurfaces. This kime characterization extends the classical protocols for analyzing time-series data and offers unique opportunities to design novel inference, prediction, classification, and regression techniques based on the corresponding kimesurface manifolds. We define complex time and illustrate alternative time-series to kimesurface transformations. Using the Laplace transform and its inverse, we demonstrate the bijective mapping between time-series and kimesurfaces. A proposed general tensor regression based linear model is validated using functional Magnetic Resonance Imaging data. This kimesurface representation method can be used with a wide range of machine learning algorithms, artificial intelligence tools, analytical approaches, and inferential techniques to interrogate multivariate, complex-domain, and complex-range longitudinal processes.