Emergency Department Triage Prediction of Clinical Outcomes Using Machine Learning Models

2019 ◽  
Vol 57 (5) ◽  
pp. 752-753
Author(s):  
Seth Bartholomew ◽  
Amanda Young
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Clinical Outcomes ◽  
Learning Models ◽  
Emergency Department Triage ◽  
Machine Learning Models

scholarly journals Emergency department triage prediction of clinical outcomes using machine learning models

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Yoshihiko Raita ◽  
Tadahiro Goto ◽  
Mohammad Kamal Faridi ◽  
David F. M. Brown ◽  
Carlos A. Camargo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Clinical Outcomes ◽  
Learning Models ◽  
Emergency Department Triage ◽  
Machine Learning Models

scholarly journals Development and validation of a prognostic COVID-19 severity assessment (COSA) score and machine learning models for patient triage at a tertiary hospital

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Verena Schöning ◽  
Evangelia Liakoni ◽  
Christine Baumgartner ◽  
Aristomenis K. Exadaktylos ◽  
Wolf E. Hautz ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Predictive Value ◽  
Validation Cohort ◽  
Tertiary Hospital ◽  
Learning Models ◽  
Clinical Risk ◽  
Machine Learning Models ◽  
Risk Stratification Score

Abstract Background Clinical risk scores and machine learning models based on routine laboratory values could assist in automated early identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients at risk for severe clinical outcomes. They can guide patient triage, inform allocation of health care resources, and contribute to the improvement of clinical outcomes. Methods In- and out-patients tested positive for SARS-CoV-2 at the Insel Hospital Group Bern, Switzerland, between February 1st and August 31st (‘first wave’, n = 198) and September 1st through November 16th 2020 (‘second wave’, n = 459) were used as training and prospective validation cohort, respectively. A clinical risk stratification score and machine learning (ML) models were developed using demographic data, medical history, and laboratory values taken up to 3 days before, or 1 day after, positive testing to predict severe outcomes of hospitalization (a composite endpoint of admission to intensive care, or death from any cause). Test accuracy was assessed using the area under the receiver operating characteristic curve (AUROC). Results Sex, C-reactive protein, sodium, hemoglobin, glomerular filtration rate, glucose, and leucocytes around the time of first positive testing (− 3 to + 1 days) were the most predictive parameters. AUROC of the risk stratification score on training data (AUROC = 0.94, positive predictive value (PPV) = 0.97, negative predictive value (NPV) = 0.80) were comparable to the prospective validation cohort (AUROC = 0.85, PPV = 0.91, NPV = 0.81). The most successful ML algorithm with respect to AUROC was support vector machines (median = 0.96, interquartile range = 0.85–0.99, PPV = 0.90, NPV = 0.58). Conclusion With a small set of easily obtainable parameters, both the clinical risk stratification score and the ML models were predictive for severe outcomes at our tertiary hospital center, and performed well in prospective validation.

scholarly journals A comparison of machine learning models versus clinical evaluation for mortality prediction in patients with sepsis

2020 ◽  
Author(s):  
William P.T.M. van Doorn ◽  
Patricia M. Stassen ◽  
Hella F. Borggreve ◽  
Maaike J. Schalkwijk ◽  
Judith Stoffers ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Machine Learning ◽  
Emergency Department ◽  
Risk Stratification ◽  
Roc Curve ◽  
Risk Scores ◽  
Validation Dataset ◽  
Learning Models ◽  
Clinical Risk ◽  
Machine Learning Models

AbstractIntroductionPatients with sepsis who present to an emergency department (ED) have highly variable underlying disease severity, and can be categorized from low to high risk. Development of a risk stratification tool for these patients is important for appropriate triage and early treatment. The aim of this study was to develop machine learning models predicting 31-day mortality in patients presenting to the ED with sepsis and to compare these to internal medicine physicians and clinical risk scores.MethodsA single-center, retrospective cohort study was conducted amongst 1,344 emergency department patients fulfilling sepsis criteria. Laboratory and clinical data that was available in the first two hours of presentation from these patients were randomly partitioned into a development (n=1,244) and validation dataset (n=100). Machine learning models were trained and evaluated on the development dataset and compared to internal medicine physicians and risk scores in the independent validation dataset. The primary outcome was 31-day mortality.ResultsA number of 1,344 patients were included of whom 174 (13.0%) died. Machine learning models trained with laboratory or a combination of laboratory + clinical data achieved an area-under-the ROC curve of 0.82 (95% CI: 0.80-0.84) and 0.84 (95% CI: 0.81-0.87) for predicting 31-day mortality, respectively. In the validation set, models outperformed internal medicine physicians and clinical risk scores in sensitivity (92% vs. 72% vs. 78%;p<0.001,all comparisons) while retaining comparable specificity (78% vs. 74% vs. 72%;p>0.02). The model had higher diagnostic accuracy with an area-under-the-ROC curve of 0.85 (95%CI: 0.78-0.92) compared to abbMEDS (0.63,0.54-0.73), mREMS (0.63,0.54-0.72) and internal medicine physicians (0.74,0.65-0.82).ConclusionMachine learning models outperformed internal medicine physicians and clinical risk scores in predicting 31-day mortality. These models are a promising tool to aid in risk stratification of patients presenting to the ED with sepsis.

scholarly journals Development and Validation of a Quick Sepsis-Related Organ Failure Assessment-Based Machine-Learning Model for Mortality Prediction in Patients with Suspected Infection in the Emergency Department

2020 ◽  
Vol 9 (3) ◽  
pp. 875
Author(s):  
Young Suk Kwon ◽  
Moon Seong Baek
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Learning Model ◽  
Gradient Boosting ◽  
Learning Models ◽  
Suspected Infection ◽  
Machine Learning Model ◽  
Failure Assessment ◽  
Qsofa Score ◽  
Machine Learning Models

The quick sepsis-related organ failure assessment (qSOFA) score has been introduced to predict the likelihood of organ dysfunction in patients with suspected infection. We hypothesized that machine-learning models using qSOFA variables for predicting three-day mortality would provide better accuracy than the qSOFA score in the emergency department (ED). Between January 2016 and December 2018, the medical records of patients aged over 18 years with suspected infection were retrospectively obtained from four EDs in Korea. Data from three hospitals (n = 19,353) were used as training-validation datasets and data from one (n = 4234) as the test dataset. Machine-learning algorithms including extreme gradient boosting, light gradient boosting machine, and random forest were used. We assessed the prediction ability of machine-learning models using the area under the receiver operating characteristic (AUROC) curve, and DeLong’s test was used to compare AUROCs between the qSOFA scores and qSOFA-based machine-learning models. A total of 447,926 patients visited EDs during the study period. We analyzed 23,587 patients with suspected infection who were admitted to the EDs. The median age of the patients was 63 years (interquartile range: 43–78 years) and in-hospital mortality was 4.0% (n = 941). For predicting three-day mortality among patients with suspected infection in the ED, the AUROC of the qSOFA-based machine-learning model (0.86 [95% CI 0.85–0.87]) for three -day mortality was higher than that of the qSOFA scores (0.78 [95% CI 0.77–0.79], p < 0.001). For predicting three-day mortality in patients with suspected infection in the ED, the qSOFA-based machine-learning model was found to be superior to the conventional qSOFA scores.

scholarly journals Machine Learning–Based Prediction of Clinical Outcomes for Children During Emergency Department Triage

2019 ◽  
Vol 2 (1) ◽  
pp. e186937 ◽  
Author(s):  
Tadahiro Goto ◽  
Carlos A. Camargo ◽  
Mohammad Kamal Faridi ◽  
Robert J. Freishtat ◽  
Kohei Hasegawa
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Clinical Outcomes ◽  
Emergency Department Triage ◽  
Outcomes For Children

scholarly journals A comparison of machine learning models versus clinical evaluation for mortality prediction in patients with sepsis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245157
Author(s):  
William P. T. M. van Doorn ◽  
Patricia M. Stassen ◽  
Hella F. Borggreve ◽  
Maaike J. Schalkwijk ◽  
Judith Stoffers ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Machine Learning ◽  
Emergency Department ◽  
Risk Stratification ◽  
Roc Curve ◽  
Risk Scores ◽  
Validation Dataset ◽  
Learning Models ◽  
Clinical Risk ◽  
Machine Learning Models

Introduction Patients with sepsis who present to an emergency department (ED) have highly variable underlying disease severity, and can be categorized from low to high risk. Development of a risk stratification tool for these patients is important for appropriate triage and early treatment. The aim of this study was to develop machine learning models predicting 31-day mortality in patients presenting to the ED with sepsis and to compare these to internal medicine physicians and clinical risk scores. Methods A single-center, retrospective cohort study was conducted amongst 1,344 emergency department patients fulfilling sepsis criteria. Laboratory and clinical data that was available in the first two hours of presentation from these patients were randomly partitioned into a development (n = 1,244) and validation dataset (n = 100). Machine learning models were trained and evaluated on the development dataset and compared to internal medicine physicians and risk scores in the independent validation dataset. The primary outcome was 31-day mortality. Results A number of 1,344 patients were included of whom 174 (13.0%) died. Machine learning models trained with laboratory or a combination of laboratory + clinical data achieved an area-under-the ROC curve of 0.82 (95% CI: 0.80–0.84) and 0.84 (95% CI: 0.81–0.87) for predicting 31-day mortality, respectively. In the validation set, models outperformed internal medicine physicians and clinical risk scores in sensitivity (92% vs. 72% vs. 78%;p<0.001,all comparisons) while retaining comparable specificity (78% vs. 74% vs. 72%;p>0.02). The model had higher diagnostic accuracy with an area-under-the-ROC curve of 0.85 (95%CI: 0.78–0.92) compared to abbMEDS (0.63,0.54–0.73), mREMS (0.63,0.54–0.72) and internal medicine physicians (0.74,0.65–0.82). Conclusion Machine learning models outperformed internal medicine physicians and clinical risk scores in predicting 31-day mortality. These models are a promising tool to aid in risk stratification of patients presenting to the ED with sepsis.

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