Emergency department triage prediction of clinical outcomes using machine learning models

Critical Care : the Official Journal of the Critical Care Forum
Yoshihiko RaitaKohei Hasegawa

Abstract

Development of emergency department (ED) triage systems that accurately differentiate and prioritize critically ill from stable patients remains challenging. We used machine learning models to predict clinical outcomes, and then compared their performance with that of a conventional approach-the Emergency Severity Index (ESI). Using National Hospital and Ambulatory Medical Care Survey (NHAMCS) ED data, from 2007 through 2015, we identified all adult patients (aged ≥ 18 years). In the randomly sampled training set (70%), using routinely available triage data as predictors (e.g., demographics, triage vital signs, chief complaints, comorbidities), we developed four machine learning models: Lasso regression, random forest, gradient boosted decision tree, and deep neural network. As the reference model, we constructed a logistic regression model using the five-level ESI data. The clinical outcomes were critical care (admission to intensive care unit or in-hospital death) and hospitalization (direct hospital admission or transfer). In the test set (the remaining 30%), we measured the predictive performance, including area under the receiver-operating-characteristics curve (AUC) and net benefit (decision curves) for each model. Of 135...Continue Reading

References

Nov 14, 2006·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Andrew J Vickers, Elena B Elkin
Feb 12, 2008·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Ewout W Steyerberg, Andrew J Vickers
May 21, 2009·BMJ : British Medical Journal·Saif S RathoreUNKNOWN National Cardiovascular Data Registry
Jun 24, 2011·BMC Medical Informatics and Decision Making·Valentin Rousson, Thomas Zumbrunn
Jan 4, 2012·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Megan McHughRahul K Khare
Dec 12, 2012·Annals of Emergency Medicine·Benjamin C SunSteven M Asch
Nov 19, 2013·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Rajiv AryaRobert M Eisenstein
Jan 11, 2014·Frontiers in Neurorobotics·Alexey Natekin, Alois Knoll
Sep 30, 2014·The Journal of Allergy and Clinical Immunology·Kohei HasegawaUNKNOWN MARC-36 Investigators
Nov 7, 2014·IEEE Journal of Biomedical and Health Informatics·Nan LiuMarcus Eng Hock Ong
Jan 23, 2015·JAMA Otolaryngology-- Head & Neck Surgery·Adrian J PriesolRichard F Lewis
Jan 28, 2015·JAMA : the Journal of the American Medical Association·Mark FitzgeraldRoger J Lewis
Dec 19, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·R Andrew TaylorM Kennedy Hall
May 3, 2016·The Journal of Emergency Medicine·Andrea Freyer DugasScott Levin
Sep 30, 2016·The New England Journal of Medicine·Ziad Obermeyer, Ezekiel J Emanuel
Feb 25, 2017·The American Journal of Emergency Medicine·David F GaieskiJesse M Pines
Mar 7, 2017·Circulation. Cardiovascular Quality and Outcomes·Bobak J MortazaviHarlan M Krumholz
Aug 18, 2017·Methods of Information in Medicine·Xingyu ZhangJustin D Schrager
May 5, 2018·KI Reports·Vijaya B KolachalamaVipul C Chitalia
Jul 5, 2018·The American Journal of Emergency Medicine·Tadahiro GotoKohei Hasegawa
Sep 23, 2018·European Urology·Ben Van CalsterEwout W Steyerberg
Sep 7, 2019·Educational and Psychological Measurement·Cengiz Zopluoglu

❮ Previous
Next ❯

Citations

Nov 30, 2019·Healthcare Informatics Research·Sae Won ChoiKyung Hwan Kim
Dec 14, 2019·PloS One·Douglas SpanglerHans Blomberg
Apr 3, 2020·Der Internist·Tobias Müller
Jul 11, 2020·BMC Medical Informatics and Decision Making·Ming ChengYafeng Ren
Jul 16, 2020·Bioelectronic Medicine·Shubham DebnathUNKNOWN Northwell COVID-19 Research Consortium
Oct 13, 2020·Emergency Medicine Australasia : EMA·Bahman TahayoriHamed Akhlaghi
Dec 6, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Hashim KareemiKrishan Yadav
Jan 26, 2020·Artificial Intelligence in Medicine·Marta FernandesJoão M C Sousa
Dec 29, 2020·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·Oleksandr IvanovChristian Reilly
Nov 13, 2020·International Journal of Cardiology·Stephanie M KochavYuichi J Shimada
Jan 11, 2021·Journal of Intensive Care·Yohei OkadaShigeru Ohtsuru
Nov 5, 2020·Journal of the American College of Emergency Physicians Open·Joshua W JosephLeon D Sanchez
Mar 23, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Sheng ShiGuyan Wang
Apr 4, 2021·International Journal of Environmental Research and Public Health·Soo-Kyoung LeeDong Eun Jang
Jan 14, 2021·Chest·Joe G ZeinAziz Nazha
Apr 4, 2021·Journal of Clinical Medicine·Oliver S MuellerRoland Bingisser
Oct 30, 2020·International Journal of Nursing Studies·Dietmar AusserhoferGianni Turcato
May 1, 2021·Medicina·Franca DipaolaRaffaello Furlan
May 12, 2021·The American Journal of Emergency Medicine·Theodore W HeymingLouis Ehwerhemuepha
Jun 3, 2021·Computer Methods and Programs in Biomedicine·Aizatul Shafiqah Mohd FaizalSiow-Wee Chang
Jun 22, 2021·BMC Medical Informatics and Decision Making·Anna LarssonMartin Gerdin Wärnberg

❮ Previous
Next ❯

Software Mentioned

R Keras
NHAMCS
gboost
R ranger caret
R glmnet package
R

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.