Temporal machine learning framework for diabetic foot ulcer healing trajectory prediction.

OBJECTIVES: Diabetic foot ulcer management relies predominantly on reactive treatment adjustments based on current wound status. This study developed an accessible machine learning framework using routinely collected clinical metadata (no imaging required) to predict healing phase transitions at the next clinical appointment, enabling proactive treatment planning with an integrated recommendation system. METHODS: Longitudinal data from 268 patients with 329 distinct ulcers across 890 appointments were analyzed. Features (n = 103) including temporal measurements normalized by inter-appointment intervals were engineered. An Extra Trees classifier was optimized via Bayesian hyperparameter tuning with impurity-based feature selection and sequential augmentation to predict three transition categories: favorable, acceptable, or unfavorable. Threefold patient-level cross-validation ensured robust performance estimation. RESULTS: Feature selection identified 30 essential predictors, achieving 70.9% dimensionality reduction. The optimized classifier demonstrated 78% ± 4% accuracy with balanced category performance (per-class F1 scores: 0.72-0.84) and average AUC of 0.90. Historical phase features dominated predictive importance. The integrated treatment recommendation system achieved 88.7% within-category agreement for offloading prescriptions across all chronicity levels. Dressing recommendations demonstrated chronicity-stratified performance, with match rates declining from 83.7% for acute wounds to 5.6% for very chronic wounds, appropriately reflecting clinical reality that treatment-resistant wounds require individualized therapeutic experimentation. CONCLUSIONS: This framework demonstrates potential for next-appointment trajectory prediction using accessible clinical metadata without specialized imaging, pending prospective validation. The chronicity-dependent recommendation performance appropriately distinguishes wounds amenable to standardized protocols from treatment-resistant cases requiring iterative experimentation.