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Liu L, Yang Y, Gao Z, Li M, Mu X, Ma X, Li G, Sun W, Wang X, Gu Q, Zheng R, Zhao H, Ao D, Yu W, Wang Y, Chen K, Yan J, Li J, Cai G, Wang Y, Wang H, Kang Y, Slutsky AS, Liu S, Xie J, Qiu H. Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study. J Thorac Dis 2018; 10:5394-5404. [PMID: 30416787 DOI: 10.21037/jtd.2018.08.137] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Although acute respiratory distress syndrome (ARDS) has been recognized for more than 50 years, limited information exists about the incidence and management of ARDS in mainland China. To evaluate the potential for improvement in management of patients with ARDS, this study was designed to describe the incidence and management of ARDS in mainland China. Methods , 2012) of all patients who fulfilled the Berlin or American European Consensus Conference (AECC) definition of ARDS in 20 intensive care units, with data collection related to the management of ARDS, patient characteristics and outcomes. Results was 90%. A recruitment maneuver was performed in 35.5% of the patients, and 8.7% of patients with severe ARDS received prone position. Overall hospital mortality was 34.0%. Hospital mortality was 21.8% for mild, 31.1% for moderate, and 60.0% for patients with severe ARDS (P=0.004). Conclusions Despite general acceptance of low Vt and limited Pplat, high driving pressure, low PEEP and low use of adjunctive measures may still be a concern in mainland China, especially in patients with severe ARDS. Trial Registration 2012.
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Affiliation(s)
- Ling Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yi Yang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Zhiwei Gao
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.,Department of Critical Care Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, China
| | - Maoqin Li
- Department of Critical Care Medicine, Xuzhou City Central Hospital, Xuzhou 221009, China
| | - Xinwei Mu
- Department of Critical Care Medicine, Nanjing First hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
| | - Guicheng Li
- Department of Critical Care Medicine, Chenzhou First People's Hospital, Chenzhou 423000, China
| | - Wen Sun
- Department of Critical Care Medicine, Jurong People's Hospital, Jurong 212400, China
| | - Xue Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Qin Gu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou 225000, China
| | - Hongsheng Zhao
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China
| | - Dan Ao
- Department of Critical Care Medicine, Lishui People's Hospital, Nanjing 210044, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
| | - Yushan Wang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun 130021, China
| | - Kang Chen
- Department of Critical Care Medicine, Zhangjiagang First People's Hospital, Zhangjiagang 215600, China
| | - Jie Yan
- Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi 214043, China
| | - Jianguo Li
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Guolong Cai
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou 310030, China
| | - Yurong Wang
- Department of Critical Care Medicine, Yangzhou First People's Hospital, Yangzhou 225001, China
| | - Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin 150040, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, West China School of Medicine, Chengdu 610041, China
| | - Arthur S Slutsky
- Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Songqiao Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Jianfen Xie
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
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Increases in Heart Rate Variability Signal Improved Outcomes in Rapid Response Team Consultations: A Cohort Study. Cardiol Res Pract 2018; 2018:1590217. [PMID: 29686889 PMCID: PMC5852903 DOI: 10.1155/2018/1590217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/17/2017] [Accepted: 12/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background Reduced heart rate variability (HRV) indicates dominance of the sympathetic system and a state of “physiologic stress.” We postulated that, in patients with critical illness, increases in HRV might signal successful resuscitation and improved prognosis. Methods We carried out a prospective observational study of HRV on all patients referred to the rapid response team (RRT) and correlated with serial vital signs, lactate clearance, ICU admission, and mortality. Results Ninety-one patients were studied. Significantly higher HRV was observed in patients who achieved physiological stability and did not need ICU admission: ASDNN 19 versus 34.5, p=0.032; rMSSD 13.5 versus 25, p=0.046; mean VLF 9.4 versus 17, p=0.021; mean LF 5.8 versus 12.4, p=0.018; and mean HF 4.7 versus 10.5, p=0.017. ROC curves confirmed the change in very low frequencies at 2 hours as a strong predictor for ICU admission with an AUC of 0.772 (95% CI 0.633, 0.911, p=0.001) and a cutoff value of −0.65 associated with a sensitivity of 78.6% and a specificity of 61%. Conclusions Reduced HRV, specifically VLF, appears closely related to greater severity of critical illness, identifies unsuccessful resuscitation, and can be used to identify consultations that need early ICU admission.
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Porta A, Colombo R, Marchi A, Bari V, De Maria B, Ranuzzi G, Guzzetti S, Fossali T, Raimondi F. Association between autonomic control indexes and mortality in subjects admitted to intensive care unit. Sci Rep 2018; 8:3486. [PMID: 29472594 PMCID: PMC5823868 DOI: 10.1038/s41598-018-21888-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/13/2018] [Indexed: 11/23/2022] Open
Abstract
This study checks whether autonomic markers derived from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) and from their interactions with spontaneous or mechanical respiration (R) are associated with mortality in patients admitted to intensive care unit (ICU). Three-hundred consecutive HP, SAP and R values were recorded during the first day in ICU in 123 patients. Population was divided into survivors (SURVs, n = 83) and non-survivors (NonSURVs, n = 40) according to the outcome. SURVs and NonSURVs were aged- and gender-matched. All subjects underwent modified head-up tilt (MHUT) by tilting the bed back rest segment to 60°. Autonomic control indexes were computed using time-domain, spectral, cross-spectral, complexity, symbolic and causality techniques via univariate, bivariate and conditional approaches. SAP indexes derived from time-domain, model-free complexity and symbolic approaches were associated with the endpoint, while none of HP variability markers was. The association was more powerful during MHUT. Linear cross-spectral and causality indexes were useless to separate SURVs from NonSURVs, while nonlinear bivariate symbolic markers were successful. When indexes were combined with clinical scores, only SAP variance provided complementary information. Cardiovascular control variability indexes, especially when derived after an autonomic challenge such as MHUT, can improve mortality risk stratification in ICU.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, 20133, Italy. .,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, 20097, Italy.
| | | | - Andrea Marchi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, 20097, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri, Istituto di Milano, Milan, 20138, Italy
| | - Giovanni Ranuzzi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, 20097, Italy
| | | | - Tommaso Fossali
- Department of Emergency, L. Sacco Hospital, Milan, 20157, Italy
| | - Ferdinando Raimondi
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Clinical and Research Center, Rozzano, 20089, Italy
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Alvarez C, Rojas E, Arias M, Munoz-Gama J, Sepúlveda M, Herskovic V, Capurro D. Discovering role interaction models in the Emergency Room using Process Mining. J Biomed Inform 2017; 78:60-77. [PMID: 29289628 DOI: 10.1016/j.jbi.2017.12.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/23/2017] [Accepted: 12/28/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES A coordinated collaboration among different healthcare professionals in Emergency Room (ER) processes is critical to promptly care for patients who arrive at the hospital in a delicate health condition, claiming for an immediate attention. The aims of this study are (i) to discover role interaction models in (ER) processes using process mining techniques; (ii) to understand how healthcare professionals are currently collaborating; and (iii) to provide useful knowledge that can help to improve ER processes. METHODS A four step method based on process mining techniques is proposed. An ER process of a university hospital was considered as a case study, using 7160 episodes that contains specific ER episode attributes. RESULTS Insights about how healthcare professionals collaborate in the ER was discovered, including the identification of a prevalent role interaction model along the major triage categories and specific role interaction models for different diagnoses. Also, common and exceptional professional interaction models were discovered at the role level. CONCLUSIONS This study allows the discovery of role interaction models through the use of real-life clinical data and process mining techniques. Results show a useful way of providing relevant insights about how healthcare professionals collaborate, uncovering opportunities for process improvement.
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Affiliation(s)
- Camilo Alvarez
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Chile.
| | - Eric Rojas
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Chile.
| | - Michael Arias
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Chile.
| | - Jorge Munoz-Gama
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Chile.
| | - Marcos Sepúlveda
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Chile.
| | - Valeria Herskovic
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Chile.
| | - Daniel Capurro
- Internal Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
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Sakamoto JT, Liu N, Koh ZX, Guo D, Heldeweg MLA, Ji Ng JC, Hock Ong ME. Heart Rate Variability Analysis in Patients Who Have Bradycardia Presenting to the Emergency Department with Chest Pain. J Emerg Med 2017; 54:273-280. [PMID: 29242010 DOI: 10.1016/j.jemermed.2017.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/15/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is a noninvasive method to measure the function of the autonomic nervous system. It has been used to risk stratify patients with undifferentiated chest pain in the emergency department (ED). However, bradycardia can have a modifying effect on HRV. OBJECTIVE In this study, we aimed to determine how bradycardia affected HRV analysis in patients who presented with chest pain to the ED. METHODS Adult patients presenting to the ED at Singapore General Hospital with chest pain were included in the study. Patients with non-sinus rhythm on electrocardiogram (ECG) were excluded. HRV parameters, including time domain, frequency domain, and nonlinear variables, were analyzed from a 5-min ECG segment. Occurrence of a major adverse cardiac event ([MACE], e.g., acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or mortality) within 30 days of presentation to the ED was also recorded. RESULTS A total of 797 patients were included for analysis with 248 patients (31.1%) with 30-day MACE and 135 patients with bradycardia (16.9%). Compared to non-bradycardic patients, bradycardic patients had significant differences in all HRV parameters suggesting an increased parasympathetic component. Among non-bradycardic patients, comparing those who did and did not have 30-day MACE, there were significant differences predominantly in time domain variables, suggesting decreased HRV. In bradycardic patients, the same analysis revealed significant differences in predominantly frequency-domain variables suggesting decreased parasympathetic input. CONCLUSIONS Chest pain patients with bradycardia have increased HRV compared to those without bradycardia. This may have important implications on HRV modeling strategies for risk stratification of bradycardic and non-bradycardic chest pain patients.
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Affiliation(s)
| | - Nan Liu
- Health Services Research Centre, Singapore Health Services, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Zhi Xiong Koh
- Faculty of Medical Sciences, University of Groningen, Netherlands
| | - Dagang Guo
- Faculty of Medical Sciences, University of Groningen, Netherlands
| | | | | | - Marcus Eng Hock Ong
- Faculty of Medical Sciences, University of Groningen, Netherlands; Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Wuytack F, Meskell P, Conway A, McDaid F, Santesso N, Hickey FG, Gillespie P, Raymakers AJN, Smith V, Devane D. The effectiveness of physiologically based early warning or track and trigger systems after triage in adult patients presenting to emergency departments: a systematic review. BMC Emerg Med 2017; 17:38. [PMID: 29212452 PMCID: PMC5719672 DOI: 10.1186/s12873-017-0148-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Changes to physiological parameters precede deterioration of ill patients. Early warning and track and trigger systems (TTS) use routine physiological measurements with pre-specified thresholds to identify deteriorating patients and trigger appropriate and timely escalation of care. Patients presenting to the emergency department (ED) are undiagnosed, undifferentiated and of varying acuity, yet the effectiveness and cost-effectiveness of using early warning systems and TTS in this setting is unclear. We aimed to systematically review the evidence on the use, development/validation, clinical effectiveness and cost-effectiveness of physiologically based early warning systems and TTS for the detection of deterioration in adult patients presenting to EDs. METHODS We searched for any study design in scientific databases and grey literature resources up to March 2016. Two reviewers independently screened results and conducted quality assessment. One reviewer extracted data with independent verification of 50% by a second reviewer. Only information available in English was included. Due to the heterogeneity of reporting across studies, results were synthesised narratively and in evidence tables. RESULTS We identified 6397 citations of which 47 studies and 1 clinical trial registration were included. Although early warning systems are increasingly used in EDs, compliance varies. One non-randomised controlled trial found that using an early warning system in the ED may lead to a change in patient management but may not reduce adverse events; however, this is uncertain, considering the very low quality of evidence. Twenty-eight different early warning systems were developed/validated in 36 studies. There is relatively good evidence on the predictive ability of certain early warning systems on mortality and ICU/hospital admission. No health economic data were identified. CONCLUSIONS Early warning systems seem to predict adverse outcomes in adult patients of varying acuity presenting to the ED but there is a lack of high quality comparative studies to examine the effect of using early warning systems on patient outcomes. Such studies should include health economics assessments.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Pauline Meskell
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Aislinn Conway
- Health Research Board Trials Methodology Research Network, Galway, Ireland
| | - Fiona McDaid
- Nurse Lead, National Emergency Medicine Programme/Clinical Nurse Manager, Emergency Department, Naas General Hospital, Naas, County Kildare Ireland
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., HSC-2C15, Hamilton, ON L8S 4K1 Canada
| | | | - Paddy Gillespie
- Health Economics & Policy Analysis Centre (HEPAC), School of Business & Economics, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Adam J. N. Raymakers
- Health Economics & Policy Analysis Centre (HEPAC), School of Business & Economics, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Valerie Smith
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Declan Devane
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
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Jelinek HF, Adam MTP, Krones R, Cornforth DJ. Diagnostic Accuracy of Random ECG in Primary Care for Early, Asymptomatic Cardiac Autonomic Neuropathy. J Diabetes Sci Technol 2017; 11:1165-1173. [PMID: 28406035 PMCID: PMC5951037 DOI: 10.1177/1932296817703670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS Cardiac autonomic reflex tests (CARTs) are time consuming and require patient cooperation for detecting cardiac autonomic neuropathy (CAN). Heart rate variability (HRV) analysis requires less patient cooperation and is quicker to complete. However the reliability of HRV results as a clinical tool, with respect to length of recording and accuracy of diagnosis is inconclusive. The current study investigated the reproducibility associated with varying length of recording for early CAN (eCAN) assessment. METHODS Participants were 68 males, 72 females with average age of 55 for controls and 63 for early CAN. Inclusion criteria were that participants were medication free and presented with no comorbidities. ECGs of control and eCAN were recorded and heart rate changes analyzed with the fast Fourier transform (FFT) and Lomb-Scargle periodogram (LSP). Ten-second to 5-minute recordings were extracted from a 15-minute lead-II ECG and accuracy in assessment of eCAN determined. RESULTS The eCAN group was older ( P < .001) and systolic blood pressure was higher ( P < .01). HDL-cholesterol was also higher in the eCAN group ( P < .05). HRV analysis showed that both FFT and LSP results were significantly different between eCAN and control down to a 10-second ECG length for low frequency (LSP: P = .013, FFT: P = .024) and high frequency (HF-LSP: P = .002, FFT: P = .002) power. eCAN assessment was optimal down to 90-second recordings with a sensitivity of 100% and specificity of 29.49%. CONCLUSION HRV is suitable for clinical practice from ECG recordings of more than 90 seconds with high accuracy and repeatability within a session for each participant.
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Affiliation(s)
- Herbert F. Jelinek
- Clinical Medicine, Macquarie University, Sydney, Australia
- Centre for Research in Complex Systems and School of Community Health, Charles Sturt University, Albury, Australia
| | - Marc T. P. Adam
- Applied Informatics Research Group, University of Newcastle, Newcastle, Australia
| | - Robert Krones
- Rural Clinical School, University of Melbourne, Shepparton, Australia
- Wangaratta Cardiology and Respiratory Centre, Wangaratta, Australia
| | - David J. Cornforth
- Applied Informatics Research Group, University of Newcastle, Newcastle, Australia
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Dervishi A. Fuzzy risk stratification and risk assessment model for clinical monitoring in the ICU. Comput Biol Med 2017; 87:169-178. [PMID: 28599216 DOI: 10.1016/j.compbiomed.2017.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND The decisions that clinicians make in intensive care units (ICUs) based on monitored parameters reflecting physiological deterioration are of major medical and biomedical engineering interest. These parameters have been investigated and assessed for their usefulness in risk assessment. METHODS Totally, 127 ICU adult patients were studied. They were selected from a MIMIC II Waveform Database Matched Subset and had continuous monitoring of heart rate, invasive blood pressure, and oxygen saturation. The monitored data were dimension reduced using deep learning autoencoders and then used to train a support vector machine model (SVM). A combination of methods including fuzzy c-means clustering (FCM), and a random forest (RF) was used to determine the risk levels. RESULTS When classifying patients into stable or deteriorating groups the main performance parameter was the receiver operating characteristics (ROC). The area under the ROC (AUROC) was 93.2 (95% CI (92.9-93.4)) with sensitivity and specificity values of 0.80 and 0.89, respectively. The suggested fuzzy risk levels using the combined method of the FCM clustering and RF achieved an accuracy of 1 (0.9999, 1), with both sensitivity and specificity values equal to 1. CONCLUSIONS The potential for using models in risk assessment to estimate a patient's physiological status, stable or deteriorating, within 4 h has been demonstrated. The study was based on retrospective analysis and further studies are needed to evaluate the impact on clinical outcomes using this model.
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Martínez-Alanis M, Ruiz-Velasco S, Lerma C. Quantitative analysis of ventricular ectopic beats in short-term RR interval recordings to predict imminent ventricular tachyarrhythmia. Int J Cardiol 2016; 225:226-233. [DOI: 10.1016/j.ijcard.2016.09.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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Managing emergency department crowding through improved triaging and resource allocation. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.orhc.2016.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments. BMC Med Inform Decis Mak 2016; 16:61. [PMID: 27260476 PMCID: PMC4893236 DOI: 10.1186/s12911-016-0305-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 06/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Methods Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Results Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Conclusions Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0305-4) contains supplementary material, which is available to authorized users.
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Oh H, Lee K, Seo W. Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in-hospital cardiac arrest. J Adv Nurs 2016; 72:1122-33. [PMID: 26768904 DOI: 10.1111/jan.12897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/26/2022]
Abstract
AIM To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting. BACKGROUND Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest. DESIGN A retrospective case-control study. METHODS The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group). RESULTS Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups. CONCLUSION The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest.
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Affiliation(s)
- HyunSoo Oh
- Department of Nursing, Inha University, Incheon, Korea
| | - KangIm Lee
- Department of Nursing, Inha University, Incheon, Korea.,Surgical Intensive Care Unit, Inha University Hospital, Incheon, Korea
| | - WhaSook Seo
- Department of Nursing, Inha University, Incheon, Korea
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Hirsch JS, Mohan S. Integrating Real Time Data to Improve Outcomes in Acute Kidney Injury. Nephron Clin Pract 2015; 131:242-6. [PMID: 26575177 DOI: 10.1159/000441981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022] Open
Abstract
Critically ill patients with acute kidney injury requiring renal replacement therapy have a poor prognosis. Despite well-known factors, which contribute to outcomes, including dose delivery, patients frequently miss the target dose and volume removal. One major barrier to effective care of these patients is the traditional dissociation of dialysis device data from other clinical information systems, notably the electronic health record (EHR). This lack of integration and the resulting manual documentation leads to errors and biases in documentation and missed opportunities to intervene in a timely fashion. This review summarizes the technological advancements facilitating direct connection of dialysis devices to EHRs. This connection facilitates automated data capture of many variables - including delivered dose, ultrafiltration rate and pressure measurements - which in turn can be leveraged for data mining, quality improvement and real-time targeted therapy adjustments. These interventions hold the promise to significantly improve outcomes for this patient population.
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Affiliation(s)
- Jamie S Hirsch
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA
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Roysden N, Wright A. Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:2063-2072. [PMID: 26958306 PMCID: PMC4765610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient's first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis.
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Affiliation(s)
| | - Adam Wright
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA
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Liu T, Lin Z, Ong MEH, Koh ZX, Pek PP, Yeo YK, Oh BS, Ho AFW, Liu N. Manifold ranking based scoring system with its application to cardiac arrest prediction: A retrospective study in emergency department patients. Comput Biol Med 2015; 67:74-82. [PMID: 26498047 DOI: 10.1016/j.compbiomed.2015.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The recently developed geometric distance scoring system has shown the effectiveness of scoring systems in predicting cardiac arrest within 72h and the potential to predict other clinical outcomes. However, the geometric distance scoring system predicts scores based on only local structure embedded by the data, thus leaving much room for improvement in terms of prediction accuracy. METHODS We developed a novel scoring system for predicting cardiac arrest within 72h. The scoring system was developed based on a semi-supervised learning algorithm, manifold ranking, which explores both the local and global consistency of the data. System evaluation was conducted on emergency department patients׳ data, including both vital signs and heart rate variability (HRV) parameters. Comparison of the proposed scoring system with previous work was given in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). RESULTS Out of 1025 patients, 52 (5.1%) met the primary outcome. Experimental results show that the proposed scoring system was able to achieve higher area under the curve (AUC) on both the balanced dataset (0.907 vs. 0.824) and the imbalanced dataset (0.774 vs. 0.734) compared to the geometric distance scoring system. CONCLUSIONS The proposed scoring system improved the prediction accuracy by utilizing the global consistency of the training data. We foresee the potential of extending this scoring system, as well as manifold ranking algorithm, to other medical decision making problems. Furthermore, we will investigate the parameter selection process and other techniques to improve performance on the imbalanced dataset.
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Affiliation(s)
- Tianchi Liu
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore.
| | - Zhiping Lin
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore.
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
| | - Zhi Xiong Koh
- Department of Emergency Medicine, Singapore General Hospital, Singapore.
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore.
| | - Yong Kiang Yeo
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore.
| | - Beom-Seok Oh
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore.
| | - Andrew Fu Wah Ho
- SingHealth Emergency Medicine Residency Program, Singapore Health Services, Singapore.
| | - Nan Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
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Pereira T, Correia C, Cardoso J. Novel Methods for Pulse Wave Velocity Measurement. J Med Biol Eng 2015; 35:555-565. [PMID: 26500469 PMCID: PMC4609308 DOI: 10.1007/s40846-015-0086-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/14/2015] [Indexed: 12/22/2022]
Abstract
The great incidence of cardiovascular (CV) diseases in the world spurs the search for new solutions to enable an early detection of pathological processes and provides more precise diagnosis based in multi-parameters assessment. The pulse wave velocity (PWV) is considered one of the most important clinical parameters for evaluate the CV risk, vascular adaptation, and therapeutic efficacy. Several studies were dedicated to find the relationship between PWV measurement and pathological status in different diseases, and proved the relevance of this parameter. The commercial devices dedicate to PWV estimation make a regional assessment (measured between two vessels), however a local measurement is more precise evaluation of artery condition, taking into account the differences in the structure of arteries. Moreover, the current devices present some limitations due to the contact nature. Emerging trends in CV monitoring are moving away from more invasive technologies to non-invasive and non-contact solutions. The great challenge is to explore the new instrumental solutions that allow the PWV assessment with fewer approximations for an accurately evaluation and relatively inexpensive techniques in order to be used in the clinical routine.
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Affiliation(s)
- Tânia Pereira
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
| | - Carlos Correia
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
| | - João Cardoso
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
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Lam SSW, Nguyen FNHL, Ng YY, Lee VPX, Wong TH, Fook-Chong SMC, Ong MEH. Factors affecting the ambulance response times of trauma incidents in Singapore. ACCIDENT; ANALYSIS AND PREVENTION 2015; 82:27-35. [PMID: 26026970 DOI: 10.1016/j.aap.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Time to definitive care is important for trauma outcomes, thus many emergency medical services (EMS) systems in the world adopt response times of ambulances as a key performance indicator. The objective of this study is to examine the underlying risk factors that can affect ambulance response times (ART) for trauma incidents, so as to derive interventional measures that can improve the ART. MATERIAL AND METHODS This was a retrospective study based on two years of trauma data obtained from the national EMS operations centre of Singapore. Trauma patients served by the national EMS provider over the period from 1 January 2011 till 31 December 2012 were included. ART was categorized into "Short" (<4min), "Intermediate" (4-8min) and "Long" (>8min) response times. A modelling framework which leveraged on both multinomial logistic (MNL) regression models and Bayesian networks was proposed for the identification of main and interaction effects. RESULTS Amongst the process-related risk factors, weather, traffic and place of incident were found to be significant. The traffic conditions on the roads were found to have the largest effect-the odds ratio (OR) of "Long" ART in heavy traffic condition was 12.98 (95% CI: 10.66-15.79) times higher than that under light traffic conditions. In addition, the ORs of "Long ART" under "Heavy Rain" condition were significantly higher (OR 1.58, 95% CI: 1.26-1.97) than calls responded under "Fine" weather. After accounting for confounders, the ORs of "Long" ART for trauma incidents at "Home" or "Commercial" locations were also significantly higher than that for "Road" incidents. CONCLUSION Traffic, weather and the place of incident were found to be significant in affecting the ART. The evaluation of factors affecting the ART enables the development of effective interventions for reducing the ART.
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Affiliation(s)
- Sean Shao Wei Lam
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Francis Ngoc Hoang Long Nguyen
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore.
| | - Vanessa Pei-Xuan Lee
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Ting Hway Wong
- Department of General Surgery, Singapore General Hospital; Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Stephanie Man Chung Fook-Chong
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital; Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital; Health Services and Systems Research, Duke-NUS Graduate Medical School, 226 Outram Road, Singapore 169039, Singapore.
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Holder AL, Clermont G. Using what you get: dynamic physiologic signatures of critical illness. Crit Care Clin 2015; 31:133-64. [PMID: 25435482 DOI: 10.1016/j.ccc.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The development and resolution of cardiopulmonary instability take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in physiologic signatures. When primary variables are collected with high enough frequency to derive new variables, this data hierarchy can be used to develop physiologic signatures. The creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exist. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve outcomes.
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Affiliation(s)
- Andre L Holder
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Autonomic nervous system activity as risk predictor in the medical emergency department: a prospective cohort study. Crit Care Med 2015; 43:1079-86. [PMID: 25738854 DOI: 10.1097/ccm.0000000000000922] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. DESIGN Prospective cohort study. SETTING Medical emergency department of a large university hospital. PATIENTS Five thousand seven hundred thirty consecutive patients of either sex in sinus rhythm, who were admitted to the medical emergency department of the University of Tübingen, Germany, between November 2010 and March 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Deceleration capacity of heart rate was calculated within the first minutes after emergency department admission. The modified early warning score was assessed from respiratory rate, heart rate, systolic blood pressure, body temperature, and level of consciousness as previously described. Primary endpoint was intrahospital mortality; secondary endpoints included transfer to the ICU as well as 30-day and 180-day mortality. One hundred forty-two patients (2.5%) reached the primary endpoint. Deceleration capacity was highly significantly lower in nonsurvivors than survivors (2.9 ± 2.1 ms vs 5.6 ± 2.9 ms; p < 0.001) and yielded an area under the receiver-operator characteristic curve of 0.780 (95% CI, 0.745-0.813). The modified early warning score model yielded an area under the receiver-operator characteristic curve of 0.706 (0.667-0.750). Implementing deceleration capacity into the modified early warning score model led to a highly significant increase of the area under the receiver-operator characteristic curve to 0.804 (0.770-0.835; p < 0.001 for difference). Deceleration capacity was also a highly significant predictor of 30-day and 180-day mortality as well as transfer to the ICU. CONCLUSIONS Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.
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Chong SL, Liu N, Barbier S, Ong MEH. Predictive modeling in pediatric traumatic brain injury using machine learning. BMC Med Res Methodol 2015; 15:22. [PMID: 25886156 PMCID: PMC4374377 DOI: 10.1186/s12874-015-0015-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/05/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pediatric traumatic brain injury (TBI) constitutes a significant burden and diagnostic challenge in the emergency department (ED). While large North American research networks have derived clinical prediction rules for the head injured child, these may not be generalizable to practices in countries with traditionally low rates of computed tomography (CT). We aim to study predictors for moderate to severe TBI in our ED population aged < 16 years. METHODS This was a retrospective case-control study based on data from a prospective surveillance head injury database. Cases were included if patients presented from 2006 to 2014, with moderate to severe TBI. Controls were age-matched head injured children from the registry, obtained in a 4 control: 1 case ratio. These children remained well on diagnosis and follow up. Demographics, history, and physical examination findings were analyzed and patients followed up for the clinical course and outcome measures of death and neurosurgical intervention. To predict moderate to severe TBI, we built a machine learning (ML) model and a multivariable logistic regression model and compared their performances by means of Receiver Operating Characteristic (ROC) analysis. RESULTS There were 39 cases and 156 age-matched controls. The following 4 predictors remained statistically significant after multivariable analysis: Involvement in road traffic accident, a history of loss of consciousness, vomiting and signs of base of skull fracture. The logistic regression model was created with these 4 variables while the ML model was built with 3 extra variables, namely the presence of seizure, confusion and clinical signs of skull fracture. At the optimal cutoff scores, the ML method improved upon the logistic regression method with respect to the area under the ROC curve (0.98 vs 0.93), sensitivity (94.9% vs 82.1%), specificity (97.4% vs 92.3%), PPV (90.2% vs 72.7%), and NPV (98.7% vs 95.4%). CONCLUSIONS In this study, we demonstrated the feasibility of using machine learning as a tool to predict moderate to severe TBI. If validated on a large scale, the ML method has the potential not only to guide discretionary use of CT, but also a more careful selection of head injured children who warrant closer monitoring in the hospital.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Nan Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Sylvaine Barbier
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
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Risk Scoring for Prediction of Acute Cardiac Complications from Imbalanced Clinical Data. IEEE J Biomed Health Inform 2014; 18:1894-902. [DOI: 10.1109/jbhi.2014.2303481] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liu N, Koh ZX, Goh J, Lin Z, Haaland B, Ting BP, Ong MEH. Prediction of adverse cardiac events in emergency department patients with chest pain using machine learning for variable selection. BMC Med Inform Decis Mak 2014; 14:75. [PMID: 25150702 PMCID: PMC4150554 DOI: 10.1186/1472-6947-14-75] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The key aim of triage in chest pain patients is to identify those with high risk of adverse cardiac events as they require intensive monitoring and early intervention. In this study, we aim to discover the most relevant variables for risk prediction of major adverse cardiac events (MACE) using clinical signs and heart rate variability. METHODS A total of 702 chest pain patients at the Emergency Department (ED) of a tertiary hospital in Singapore were included in this study. The recruited patients were at least 30 years of age and who presented to the ED with a primary complaint of non-traumatic chest pain. The primary outcome was a composite of MACE such as death and cardiac arrest within 72 h of arrival at the ED. For each patient, eight clinical signs such as blood pressure and temperature were measured, and a 5-min ECG was recorded to derive heart rate variability parameters. A random forest-based novel method was developed to select the most relevant variables. A geometric distance-based machine learning scoring system was then implemented to derive a risk score from 0 to 100. RESULTS Out of 702 patients, 29 (4.1%) met the primary outcome. We selected the 3 most relevant variables for predicting MACE, which were systolic blood pressure, the mean RR interval and the mean instantaneous heart rate. The scoring system with these 3 variables produced an area under the curve (AUC) of 0.812, and a cutoff score of 43 gave a sensitivity of 82.8% and specificity of 63.4%, while the scoring system with all the 23 variables had an AUC of 0.736, and a cutoff score of 49 gave a sensitivity of 72.4% and specificity of 63.0%. Conventional thrombolysis in myocardial infarction score and the modified early warning score achieved AUC values of 0.637 and 0.622, respectively. CONCLUSIONS It is observed that a few predictors outperformed the whole set of variables in predicting MACE within 72 h. We conclude that more predictors do not necessarily guarantee better prediction results. Furthermore, machine learning-based variable selection seems promising in discovering a few relevant and significant measures as predictors.
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Affiliation(s)
| | | | | | | | | | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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