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Chen JY, Hsieh CC, Lee JT, Lin CH, Kao CY. Patient stratification based on the risk of severe illness in emergency departments through collaborative machine learning models. Am J Emerg Med 2024; 82:142-152. [PMID: 38908339 DOI: 10.1016/j.ajem.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/18/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024] Open
Abstract
OBJECTIVES Emergency department (ED) overcrowding presents a global challenge that inhibits prompt care for critically ill patients. Traditional 5-level triage system that heavily rely on the judgment of the triage staff could fail to detect subtle symptoms in critical patients, thus leading to delayed treatment. Unlike previous rivalry-focused approaches, our study aimed to establish a collaborative machine learning (ML) model that renders risk scores for severe illness, which may assist the triage staff to provide a better patient stratification for timely critical cares. METHODS This retrospective study was conducted at a tertiary teaching hospital. Data were collected from January 2015 to October 2022. Demographic and clinical information were collected at triage. The study focused on severe illness as the outcome. We developed artificial neural network (ANN) models, with or without utilizing the Taiwan Triage and Acuity Scale (TTAS) score as one of the predictors. The model using the TTAS score is termed a machine-human collaborative model (ANN-MH), while the model without it is referred to as a machine-only model (ANN-MO). The predictive power of these models was assessed using the area under the receiver-operating-characteristic (AUROC) and the precision-recall curves (AUPRC); their sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score were compared. RESULTS The study analyzed 668,602 ED visits from 2015 to 2022. Among them, 278,724 visits from 2015 to 2018 were used for model training and validation, while 320,201 visits from 2019 to 2022 were for testing model performance. Approximately 2.6% of visits were by severely ill patients, whose TTAS scores ranged from 1 to 5. The ANN-MH model achieved a testing AUROC of 0.918 and AUPRC of 0.369, while for the ANN-MO model the AUROC and AUPRC were 0.909 and 0.339, respectively. Based on these metrics, the ANN-MH model outperformed the ANN-MO model, and both surpassed human triage classification. Subgroup analyses further highlighted the models' capability to identify higher-risk patients within the same triage level. CONCLUSIONS The traditional 5-level triage system often falls short, leading to under-triage of critical patients. Our models include a score-based differentiation within a triage level to offer advanced risk stratification, thereby promoting patient safety.
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Affiliation(s)
- Jui-Ying Chen
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Chia Hsieh
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Ting Lee
- School of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yao Kao
- Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Raheem A, Waheed S, Karim M, Khan NU, Jawed R. Prediction of major adverse cardiac events in the emergency department using an artificial neural network with a systematic grid search. Int J Emerg Med 2024; 17:4. [PMID: 38178007 PMCID: PMC10768150 DOI: 10.1186/s12245-023-00573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The aim of our research was to design and evaluate an Artificial Neural Network (ANN) model using a systemic grid search for the early prediction of major adverse cardiac events (MACE) among patients presenting to the triage of an emergency department. METHODS This is a single-center, cross-sectional study using electronic health records from January 2017 to December 2020. The research population consists of adults coming to our emergency department triage at Aga Khan University Hospital. The MACE during hospitalization was the main outcome. To enhance the architecture of an ANN using triage data, we used a systematic grid search strategy. Four hidden ANN layers were used, followed by an output layer. Following each hidden layer was back normalization and a dropout layer. MACE was predicted using three binary classifiers: ANN, Random Forests (RF), and logistic regression (LR). The overall accuracy, sensitivity, specificity, precision, and recall of these models were examined. Each model was evaluated using the receiver operating characteristic curve (ROC) and an F1-score with a 95% confidence interval. RESULTS A total of 97,333 emergency department visits were recorded during the study period, with 33% of patients having cardiovascular symptoms. The mean age was 54.08 (19.18) years old. The MACE was observed in 23,052 (23.7%) of the patients, in-hospital (up to 30 days) mortality in 10,888 (11.2%) patients, and cardiac arrest in 5483 (5.6%) patients. The data used for training and validation were 77,866 and 19,467 in an 80:20 ratio, respectively. The AUC score for MACE with ANN was 0.97, which was greater than RF (0.96) and LR (0.96). Similarly, the precision-recall curve for MACE utilizing ANN was greater (0.94 vs. 0.93 for RF and 0.93 for LR). The sensitivity for MACE prediction using ANN, RF, and LR classifiers was 99.3%, 99.4%, and 99.2%, respectively, with the specificities being 94.5%, 94.2%, and 94.2%, respectively. CONCLUSION When triage data is used to predict MACE, death, and cardiac arrest, ANN with systemic grid search gives precise and valid outcomes and will benefit in predicting MACE in emergency rooms with limited resources that have to deal with a substantial number of patients.
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Affiliation(s)
- Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahan Waheed
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | - Musa Karim
- Department of Clinical Research, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rida Jawed
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Ding X, Wang Y, Ma W, Peng Y, Huang J, Wang M, Zhu H. Development of early prediction model of in-hospital cardiac arrest based on laboratory parameters. Biomed Eng Online 2023; 22:116. [PMID: 38057823 DOI: 10.1186/s12938-023-01178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is an acute disease with a high fatality rate that burdens individuals, society, and the economy. This study aimed to develop a machine learning (ML) model using routine laboratory parameters to predict the risk of IHCA in rescue-treated patients. METHODS This retrospective cohort study examined all rescue-treated patients hospitalized at the First Medical Center of the PLA General Hospital in Beijing, China, from January 2016 to December 2020. Five machine learning algorithms, including support vector machine, random forest, extra trees classifier (ETC), decision tree, and logistic regression algorithms, were trained to develop models for predicting IHCA. We included blood counts, biochemical markers, and coagulation markers in the model development. We validated model performance using fivefold cross-validation and used the SHapley Additive exPlanation (SHAP) for model interpretation. RESULTS A total of 11,308 participants were included in the study, of which 7779 patients remained. Among these patients, 1796 (23.09%) cases of IHCA occurred. Among five machine learning models for predicting IHCA, the ETC algorithm exhibited better performance, with an AUC of 0.920, compared with the other four machine learning models in the fivefold cross-validation. The SHAP showed that the top ten factors accounting for cardiac arrest in rescue-treated patients are prothrombin activity, platelets, hemoglobin, N-terminal pro-brain natriuretic peptide, neutrophils, prothrombin time, serum albumin, sodium, activated partial thromboplastin time, and potassium. CONCLUSIONS We developed a reliable machine learning-derived model that integrates readily available laboratory parameters to predict IHCA in patients treated with rescue therapy.
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Affiliation(s)
- Xinhuan Ding
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Yingchan Wang
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Weiyi Ma
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Yaojun Peng
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Jingjing Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
- Department of Emergency, Hainan Hospital of PLA General Hospital, Sanya, 572013, Hainan, China
| | - Meng Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Haiyan Zhu
- Medical School of Chinese PLA, Beijing, 100853, China.
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, People's Republic of China.
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Lashen H, St John TL, Almallah YZ, Sasidhar M, Shamout FE. Machine Learning Models Versus the National Early Warning Score System for Predicting Deterioration: Retrospective Cohort Study in the United Arab Emirates. JMIR AI 2023; 2:e45257. [PMID: 38875543 PMCID: PMC11041421 DOI: 10.2196/45257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 08/01/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND Early warning score systems are widely used for identifying patients who are at the highest risk of deterioration to assist clinical decision-making. This could facilitate early intervention and consequently improve patient outcomes; for example, the National Early Warning Score (NEWS) system, which is recommended by the Royal College of Physicians in the United Kingdom, uses predefined alerting thresholds to assign scores to patients based on their vital signs. However, there is limited evidence of the reliability of such scores across patient cohorts in the United Arab Emirates. OBJECTIVE Our aim in this study was to propose a data-driven model that accurately predicts in-hospital deterioration in an inpatient cohort in the United Arab Emirates. METHODS We conducted a retrospective cohort study using a real-world data set that consisted of 16,901 unique patients associated with 26,073 inpatient emergency encounters and 951,591 observation sets collected between April 2015 and August 2021 at a large multispecialty hospital in Abu Dhabi, United Arab Emirates. The observation sets included routine measurements of heart rate, respiratory rate, systolic blood pressure, level of consciousness, temperature, and oxygen saturation, as well as whether the patient was receiving supplementary oxygen. We divided the data set of 16,901 unique patients into training, validation, and test sets consisting of 11,830 (70%; 18,319/26,073, 70.26% emergency encounters), 3397 (20.1%; 5206/26,073, 19.97% emergency encounters), and 1674 (9.9%; 2548/26,073, 9.77% emergency encounters) patients, respectively. We defined an adverse event as the occurrence of admission to the intensive care unit, mortality, or both if the patient was admitted to the intensive care unit first. On the basis of 7 routine vital signs measurements, we assessed the performance of the NEWS system in detecting deterioration within 24 hours using the area under the receiver operating characteristic curve (AUROC). We also developed and evaluated several machine learning models, including logistic regression, a gradient-boosting model, and a feed-forward neural network. RESULTS In a holdout test set of 2548 encounters with 95,755 observation sets, the NEWS system achieved an overall AUROC value of 0.682 (95% CI 0.673-0.690). In comparison, the best-performing machine learning models, which were the gradient-boosting model and the neural network, achieved AUROC values of 0.778 (95% CI 0.770-0.785) and 0.756 (95% CI 0.749-0.764), respectively. Our interpretability results highlight the importance of temperature and respiratory rate in predicting patient deterioration. CONCLUSIONS Although traditional early warning score systems are the dominant form of deterioration prediction models in clinical practice today, we strongly recommend the development and use of cohort-specific machine learning models as an alternative. This is especially important in external patient cohorts that were unseen during model development.
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Affiliation(s)
- Hazem Lashen
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | | | - Madhu Sasidhar
- Cleveland Clinic Tradition Hospital, Port St. Lucie, FL, United States
| | - Farah E Shamout
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Pungitore S, Subbian V. Assessment of Prediction Tasks and Time Window Selection in Temporal Modeling of Electronic Health Record Data: a Systematic Review. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:313-331. [PMID: 37637723 PMCID: PMC10449760 DOI: 10.1007/s41666-023-00143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 04/12/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
Temporal electronic health record (EHR) data are often preferred for clinical prediction tasks because they offer more complete representations of a patient's pathophysiology than static data. A challenge when working with temporal EHR data is problem formulation, which includes defining the time windows of interest and the prediction task. Our objective was to conduct a systematic review that assessed the definition and reporting of concepts relevant to temporal clinical prediction tasks. We searched PubMed® and IEEE Xplore® databases for studies from January 1, 2010 applying machine learning models to EHR data for patient outcome prediction. Publications applying time-series methods were selected for further review. We identified 92 studies and summarized them by clinical context and definition and reporting of the prediction problem. For the time windows of interest, 12 studies did not discuss window lengths, 57 used a single set of window lengths, and 23 evaluated the relationship between window length and model performance. We also found that 72 studies had appropriate reporting of the prediction task. However, evaluation of prediction problem formulation for temporal EHR data was complicated by heterogeneity in assessing and reporting of these concepts. Even among studies modeling similar clinical outcomes, there were variations in terminology used to describe the prediction problem, rationale for window lengths, and determination of the outcome of interest. As temporal modeling using EHR data expands, minimal reporting standards should include time-series specific concerns to promote rigor and reproducibility in future studies and facilitate model implementation in clinical settings. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00143-4.
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Affiliation(s)
- Sarah Pungitore
- Program in Applied Mathematics, Department of Mathematics, 617 N Santa Rita Ave, Tucson, AZ 85721 USA
| | - Vignesh Subbian
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721-0020 USA
- Department of Systems and Industrial Engineering, The University of Arizona, Tucson, AZ 85721-0020 USA
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Holmström L, Zhang FZ, Ouyang D, Dey D, Slomka PJ, Chugh SS. Artificial Intelligence in Ventricular Arrhythmias and Sudden Death. Arrhythm Electrophysiol Rev 2023; 12:e17. [PMID: 37457439 PMCID: PMC10345967 DOI: 10.15420/aer.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/16/2023] [Indexed: 07/18/2023] Open
Abstract
Sudden cardiac arrest due to lethal ventricular arrhythmias is a major cause of mortality worldwide and results in more years of potential life lost than any individual cancer. Most of these sudden cardiac arrest events occur unexpectedly in individuals who have not been identified as high-risk due to the inadequacy of current risk stratification tools. Artificial intelligence tools are increasingly being used to solve complex problems and are poised to help with this major unmet need in the field of clinical electrophysiology. By leveraging large and detailed datasets, artificial intelligence-based prediction models have the potential to enhance the risk stratification of lethal ventricular arrhythmias. This review presents a synthesis of the published literature and a discussion of future directions in this field.
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Affiliation(s)
- Lauri Holmström
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Frank Zijun Zhang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - David Ouyang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Damini Dey
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Sumeet S Chugh
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
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7
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Viderman D, Abdildin YG, Batkuldinova K, Badenes R, Bilotta F. Artificial Intelligence in Resuscitation: A Scoping Review. J Clin Med 2023; 12:jcm12062254. [PMID: 36983255 PMCID: PMC10054374 DOI: 10.3390/jcm12062254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Cardiac arrest is a significant cause of premature mortality and severe disability. Despite the death rate steadily decreasing over the previous decade, only 22% of survivors achieve good clinical status and only 25% of patients survive until their discharge from the hospital. The objective of this scoping review was to review relevant AI modalities and the main potential applications of AI in resuscitation. Methods: We conducted the literature search for related studies in PubMed, EMBASE, and Google Scholar. We included peer-reviewed publications and articles in the press, pooling and characterizing the data by their model types, goals, and benefits. Results: After identifying 268 original studies, we chose 59 original studies (reporting 1,817,419 patients) to include in the qualitative synthesis. AI-based methods appear to be superior to traditional methods in achieving high-level performance. Conclusion: AI might be useful in predicting cardiac arrest, heart rhythm disorders, and post-cardiac arrest outcomes, as well as in the delivery of drone-delivered defibrillators and notification of dispatchers. AI-powered technologies could be valuable assistants to continuously track patient conditions. Healthcare professionals should assist in the research and development of AI-powered technologies as well as their implementation into clinical practice.
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Affiliation(s)
- Dmitriy Viderman
- Department of Surgery, Nazarbayev University School of Medicine (NUSOM), Kerei, Zhanibek khandar Str. 5/1, Astana 010000, Kazakhstan;
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
| | - Kamila Batkuldinova
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46001 Valencia, Spain
- Correspondence:
| | - Federico Bilotta
- Department of Anesthesia and Intensive Care, University La Sapienza, 00185 Rome, Italy
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Grant L, Joo P, Nemnom MJ, Thiruganasambandamoorthy V. Machine learning versus traditional methods for the development of risk stratification scores: a case study using original Canadian Syncope Risk Score data. Intern Emerg Med 2022; 17:1145-1153. [PMID: 34734350 DOI: 10.1007/s11739-021-02873-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022]
Abstract
Artificial Intelligence and machine learning (ML) methods are promising for risk-stratification, but the added benefit over traditional statistical methods remains unclear. We compared predictive models developed using machine learning (ML) methods to the Canadian Syncope Risk Score (CSRS), a risk-tool developed with logistic regression for predicting serious adverse events (SAE) after emergency department (ED) disposition for syncope. We used the prospective multicenter cohort data collected for CSRS development at 11 Canadian EDs over an 8-year period to develop four ML models to predict 30-day SAE (death, arrhythmias, MI, structural heart disease, pulmonary embolism, hemorrhage) after ED disposition. The CSRS derivation and validation cohorts were used for training and testing, respectively, and the 43 variables used included demographics, medical history, vital signs, ECG findings, blood tests and the diagnostic impression of the emergency physician. Performance was assessed using the area under the receiver-operating-characteristics curve (AUC) and calibration curves. Of the 4030 patients in the training set and 3819 patients in the test set overall, 286 (3.6%) patients suffered 30-day SAE. The AUCs for model validation in test data were CSRS 0.902 (0.877-0.926), regularized regression 0.903 (0.877-0.928), gradient boosting 0.914 (0.894-0.934), deep neural network 0.906 (0.883-0.929), simplified gradient boosting 0.904 (0.881-0.927). The AUCs and calibration slopes for the ML models and CSRS were similar. Two ML models used fewer predictors than the CSRS but matched its performance. Overall, the ML models matched the CSRS in performance, with some models using fewer predictors.
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Affiliation(s)
- Lars Grant
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Research Institute, Montreal, QC, Canada
- Jewish General Hospital, Montreal, QC, Canada
| | - Pil Joo
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Emergency Medicine, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Venkatesh Thiruganasambandamoorthy
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Emergency Medicine, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Boonstra A, Laven M. Influence of artificial intelligence on the work design of emergency department clinicians a systematic literature review. BMC Health Serv Res 2022; 22:669. [PMID: 35585603 PMCID: PMC9118875 DOI: 10.1186/s12913-022-08070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This systematic literature review aims to demonstrate how Artificial Intelligence (AI) is currently used in emergency departments (ED) and how it alters the work design of ED clinicians. AI is still new and unknown to many healthcare professionals in emergency care, leading to unfamiliarity with its capabilities. Method Various criteria were used to establish the suitability of the articles to answer the research question. This study was based on 34 selected peer-reviewed papers on the use of Artificial Intelligence (AI) in the Emergency Department (ED), published in the last five years. Drawing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all articles were scanned, read full-text, and analyzed afterward. Results The majority of the AI applications consisted of AI-based tools to aid with clinical decisions and to relieve overcrowded EDs of their burden. AI support was mostly offered during triage, the moment that sets the patient trajectory. There is ample evidence that AI-based applications could improve the clinical decision-making process. Conclusion The use of AI in EDs is still in its nascent stages. Many studies focus on the question of whether AI has clinical utility, such as decision support, improving resource allocation, reducing diagnostic errors, and promoting proactivity. Some studies suggest that AI-based tools essentially have the ability to outperform human skills. However, it is evident from the literature that current technology does not have the aims or power to do so. Nevertheless, AI-based tools can impact clinician work design in the ED by providing support with clinical decisions, which could ultimately help alleviate a portion of the increasing clinical burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08070-7.
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Affiliation(s)
- Albert Boonstra
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
| | - Mente Laven
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Ekelund U, de Capretz PO. Moving forward with machine learning models in acute chest pain. Lancet Digit Health 2022; 4:e291-e292. [DOI: 10.1016/s2589-7500(22)00046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Liu N, Xie F, Siddiqui FJ, Ho AFW, Chakraborty B, Nadarajan GD, Tan KBK, Ong MEH. Leveraging Large-Scale Electronic Health Records and Interpretable Machine Learning for Clinical Decision Making at the Emergency Department: Protocol for System Development and Validation. JMIR Res Protoc 2022; 11:e34201. [PMID: 35333179 PMCID: PMC9492092 DOI: 10.2196/34201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background There is a growing demand globally for emergency department (ED) services. An increase in ED visits has resulted in overcrowding and longer waiting times. The triage process plays a crucial role in assessing and stratifying patients’ risks and ensuring that the critically ill promptly receive appropriate priority and emergency treatment. A substantial amount of research has been conducted on the use of machine learning tools to construct triage and risk prediction models; however, the black box nature of these models has limited their clinical application and interpretation. Objective In this study, we plan to develop an innovative, dynamic, and interpretable System for Emergency Risk Triage (SERT) for risk stratification in the ED by leveraging large-scale electronic health records (EHRs) and machine learning. Methods To achieve this objective, we will conduct a retrospective, single-center study based on a large, longitudinal data set obtained from the EHRs of the largest tertiary hospital in Singapore. Study outcomes include adverse events experienced by patients, such as the need for an intensive care unit and inpatient death. With preidentified candidate variables drawn from expert opinions and relevant literature, we will apply an interpretable machine learning–based AutoScore to develop 3 SERT scores. These 3 scores can be used at different times in the ED, that is, on arrival, during ED stay, and at admission. Furthermore, we will compare our novel SERT scores with established clinical scores and previously described black box machine learning models as baselines. Receiver operating characteristic analysis will be conducted on the testing cohorts for performance evaluation. Results The study is currently being conducted. The extracted data indicate approximately 1.8 million ED visits by over 810,000 unique patients. Modelling results are expected to be published in 2022. Conclusions The SERT scoring system proposed in this study will be unique and innovative because of its dynamic nature and modelling transparency. If successfully validated, our proposed solution will establish a standard for data processing and modelling by taking advantage of large-scale EHRs and interpretable machine learning tools. International Registered Report Identifier (IRRID) DERR1-10.2196/34201
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Affiliation(s)
- Nan Liu
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Institute of Data Science, National University of Singapore, Singapore, Singapore.,SingHealth AI Health Program, Singapore Health Services, Singapore, Singapore.,Health Service Research Centre, Singapore Health Services, Singapore, Singapore
| | - Feng Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Fahad Javaid Siddiqui
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Bibhas Chakraborty
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Statistics and Data Science, National University of Singapore, Singapore, Singapore.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | | | | | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Health Service Research Centre, Singapore Health Services, Singapore, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Douthit BJ, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Forbes T, Gao G, Kapetanovic TA, Lee MA, Pruinelli L, Schultz MA, Wieben A, Jeffery AD. Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature. Appl Clin Inform 2022; 13:161-179. [PMID: 35139564 PMCID: PMC8828453 DOI: 10.1055/s-0041-1742218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications. OBJECTIVES This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature. METHODS We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture. RESULTS Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing. CONCLUSION This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.
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Affiliation(s)
- Brian J. Douthit
- Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Rachel L. Walden
- Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee, United States
| | - Kenrick Cato
- Department of Emergency Medicine, Columbia University School of Nursing, New York, New York, United States
| | - Cynthia P. Coviak
- Professor Emerita of Nursing, Grand Valley State University, Allendale, Michigan, United States
| | - Christopher Cruz
- Global Health Technology and Informatics, Chevron, San Ramon, California, United States
| | - Fabio D'Agostino
- Department of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Thompson Forbes
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Grace Gao
- Department of Nursing, St Catherine University, Saint Paul, Minnesota, United States
| | - Theresa A. Kapetanovic
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Mikyoung A. Lee
- College of Nursing, Texas Woman's University, Denton, Texas, United States
| | - Lisiane Pruinelli
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Mary A. Schultz
- Department of Nursing, California State University, San Bernardino, California, United States
| | - Ann Wieben
- School of Nursing, University of Wisconsin-Madison, Wisconsin, United States
| | - Alvin D. Jeffery
- School of Nursing, Vanderbilt University; Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, United States,Address for correspondence Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC 461 21st Avenue South, Nashville, TN 37240United States
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Ojha U, Ayathamattam J, Okonkwo K, Ogunmwonyi I. Recent Updates and Technological Developments in Evaluating Cardiac Syncope in the Emergency Department. Curr Cardiol Rev 2022; 18:e210422203887. [PMID: 35593355 PMCID: PMC9893151 DOI: 10.2174/1573403x18666220421110935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022] Open
Abstract
Syncope is a commonly encountered problem in the emergency department (ED), accounting for approximately 3% of presenting complaints. Clinical assessment of syncope can be challenging due to the diverse range of conditions that can precipitate the symptom. Annual mortality for patients presenting with syncope ranges from 0-12%, and if the syncope is secondary to a cardiac cause, then this figure rises to 18-33%. In ED, it is paramount to accurately identify those presenting with syncope, especially patients with an underlying cardiac aetiology, initiate appropriate management, and refer them for further investigations. In 2018, the European Society of Cardiology (ESC) updated its guidelines with regard to diagnosing and managing patients with syncope. We highlight recent developments and considerations in various components of the workup, such as history, physical examination, investigations, risk stratification, and novel biomarkers, since the establishment of the 2018 ESC guidelines. We further discuss the emerging role of artificial intelligence in diagnosing cardiac syncope and postulate how wearable technology may transform evaluating cardiac syncope in ED.
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Affiliation(s)
- Utkarsh Ojha
- Department of Cardiology, Royal Brompton & Harefield Hospitals, England, UK
| | - James Ayathamattam
- Department of Medicine, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Kenneth Okonkwo
- Department of Medicine, Royal Lancaster Infirmary, Lancaster, United Kingdom
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Alamgir A, Mousa O, Shah Z. Artificial Intelligence in Predicting Cardiac Arrest: Scoping Review. JMIR Med Inform 2021; 9:e30798. [PMID: 34927595 PMCID: PMC8726033 DOI: 10.2196/30798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac arrest is a life-threatening cessation of activity in the heart. Early prediction of cardiac arrest is important, as it allows for the necessary measures to be taken to prevent or intervene during the onset. Artificial intelligence (AI) technologies and big data have been increasingly used to enhance the ability to predict and prepare for the patients at risk. OBJECTIVE This study aims to explore the use of AI technology in predicting cardiac arrest as reported in the literature. METHODS A scoping review was conducted in line with the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Scopus, ScienceDirect, Embase, the Institute of Electrical and Electronics Engineers, and Google Scholar were searched to identify relevant studies. Backward reference list checks of the included studies were also conducted. Study selection and data extraction were independently conducted by 2 reviewers. Data extracted from the included studies were synthesized narratively. RESULTS Out of 697 citations retrieved, 41 studies were included in the review, and 6 were added after backward citation checking. The included studies reported the use of AI in the prediction of cardiac arrest. Of the 47 studies, we were able to classify the approaches taken by the studies into 3 different categories: 26 (55%) studies predicted cardiac arrest by analyzing specific parameters or variables of the patients, whereas 16 (34%) studies developed an AI-based warning system. The remaining 11% (5/47) of studies focused on distinguishing patients at high risk of cardiac arrest from patients who were not at risk. Two studies focused on the pediatric population, and the rest focused on adults (45/47, 96%). Most of the studies used data sets with a size of <10,000 samples (32/47, 68%). Machine learning models were the most prominent branch of AI used in the prediction of cardiac arrest in the studies (38/47, 81%), and the most used algorithm was the neural network (23/47, 49%). K-fold cross-validation was the most used algorithm evaluation tool reported in the studies (24/47, 51%). CONCLUSIONS AI is extensively used to predict cardiac arrest in different patient settings. Technology is expected to play an integral role in improving cardiac medicine. There is a need for more reviews to learn the obstacles to the implementation of AI technologies in clinical settings. Moreover, research focusing on how to best provide clinicians with support to understand, adapt, and implement this technology in their practice is also necessary.
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Affiliation(s)
- Asma Alamgir
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Osama Mousa
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Zubair Shah
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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15
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Combining genetic risk score with artificial neural network to predict the efficacy of folic acid therapy to hyperhomocysteinemia. Sci Rep 2021; 11:21430. [PMID: 34728708 PMCID: PMC8563886 DOI: 10.1038/s41598-021-00938-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022] Open
Abstract
Artificial neural network (ANN) is the main tool to dig data and was inspired by the human brain and nervous system. Several studies clarified its application in medicine. However, none has applied ANN to predict the efficacy of folic acid treatment to Hyperhomocysteinemia (HHcy). The efficacy has been proved to associate with both genetic and environmental factors while previous studies just focused on the latter one. The explained variance genetic risk score (EV-GRS) had better power and could represent the effect of genetic architectures. Our aim was to add EV-GRS into environmental factors to establish ANN to predict the efficacy of folic acid therapy to HHcy. We performed the prospective cohort research enrolling 638 HHcy patients. The multilayer perception algorithm was applied to construct ANN. To evaluate the effect of ANN, we also established logistic regression (LR) model to compare with ANN. According to our results, EV-GRS was statistically associated with the efficacy no matter analyzed as a continuous variable (OR = 3.301, 95%CI 1.954-5.576, P < 0.001) or category variable (OR = 3.870, 95%CI 2.092-7.159, P < 0.001). In our ANN model, the accuracy was 84.78%, the Youden's index was 0.7073 and the AUC was 0.938. These indexes above indicated higher power. When compared with LR, the AUC, accuracy, and Youden's index of the ANN model (84.78%, 0.938, 0.7073) were all slightly higher than the LR model (83.33% 0.910, 0.6687). Therefore, clinical application of the ANN model may be able to better predict the folic acid efficacy to HHcy than the traditional LR model. When testing two models in the validation set, we got the same conclusion. This study appears to be the first one to establish the ANN model which added EV-GRS into environmental factors to predict the efficacy of folic acid to HHcy. This model would be able to offer clinicians a new method to make decisions and individual therapeutic plans.
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Wu TT, Zheng RF, Lin ZZ, Gong HR, Li H. A machine learning model to predict critical care outcomes in patient with chest pain visiting the emergency department. BMC Emerg Med 2021; 21:112. [PMID: 34620086 PMCID: PMC8496015 DOI: 10.1186/s12873-021-00501-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Background Currently, the risk stratification of critically ill patient with chest pain is a challenge. We aimed to use machine learning approach to predict the critical care outcomes in patients with chest pain, and simultaneously compare its performance with HEART, GRACE, and TIMI scores. Methods This was a retrospective, case-control study in patients with acute non-traumatic chest pain who presented to the emergency department (ED) between January 2017 and December 2019. The outcomes included cardiac arrest, transfer to ICU, and death during treatment in ED. In the randomly sampled training set (70%), a LASSO regression model was developed, and presented with nomogram. The performance was measured in both training set (70% participants) and testing set (30% participants), and findings were compared with the three widely used scores. Results We proposed a LASSO regression model incorporating mode of arrival, reperfusion therapy, Killip class, systolic BP, serum creatinine, creatine kinase-MB, and brain natriuretic peptide as independent predictors of critical care outcomes in patients with chest pain. Our model significantly outperformed the HEART, GRACE, TIMI score with AUC of 0.953 (95%CI: 0.922–0.984), 0.754 (95%CI: 0.675–0.832), 0.747 (95%CI: 0.664–0.829), 0.735 (95%CI: 0.655–0.815), respectively. Consistently, our model demonstrated better outcomes regarding the metrics of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. Similarly, the decision curve analysis elucidated a greater net benefit of our model over the full ranges of clinical thresholds. Conclusion We present an accurate model for predicting the critical care outcomes in patients with chest pain, and provide substantial support to its application as a decision-making tool in ED.
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Affiliation(s)
- Ting Ting Wu
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Ruo Fei Zheng
- Department of Emergency, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Zhi Zhong Lin
- Department of Radiotherapy, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
| | - Hai Rong Gong
- Department of Nursing, Fujian Health College, Fuzhou, Fujian, China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, China. .,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China. .,Department of Nursing, Fujian Provincial Hospital, Fuzhou, Fujian, China.
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Machine Learning Models for Survival and Neurological Outcome Prediction of Out-of-Hospital Cardiac Arrest Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9590131. [PMID: 34589553 PMCID: PMC8476270 DOI: 10.1155/2021/9590131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/20/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a major health problem worldwide, and neurologic injury remains the leading cause of morbidity and mortality among survivors of OHCA. The purpose of this study was to investigate whether a machine learning algorithm could detect complex dependencies between clinical variables in emergency departments in OHCA survivors and perform reliable predictions of favorable neurologic outcomes. Methods This study included adults (≥18 years of age) with a sustained return of spontaneous circulation after successful resuscitation from OHCA between 1 January 2004 and 31 December 2014. We applied three machine learning algorithms, including logistic regression (LR), support vector machine (SVM), and extreme gradient boosting (XGB). The primary outcome was a favorable neurological outcome at hospital discharge, defined as a Glasgow-Pittsburgh cerebral performance category of 1 to 2. The secondary outcome was a 30-day survival rate and survival-to-discharge rate. Results The final analysis included 1071 participants from the study period. For neurologic outcome prediction, the area under the receiver operating curve (AUC) was 0.819, 0.771, and 0.956 in LR, SVM, and XGB, respectively. The sensitivity and specificity were 0.875 and 0.751 in LR, 0.687 and 0.793 in SVM, and 0.875 and 0.904 in XGB. The AUC was 0.766 and 0.732 in LR, 0.749 and 0.725 in SVM, and 0.866 and 0.831 in XGB, for survival-to-discharge and 30-day survival, respectively. Conclusions Prognostic models trained with ML technique showed appropriate calibration and high discrimination for survival and neurologic outcome of OHCA without using prehospital data, with XGB exhibiting the best performance.
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Wu KH, Cheng FJ, Tai HL, Wang JC, Huang YT, Su CM, Chang YN. Predicting in-hospital mortality in adult non-traumatic emergency department patients: a retrospective comparison of the Modified Early Warning Score (MEWS) and machine learning approach. PeerJ 2021; 9:e11988. [PMID: 34513328 PMCID: PMC8395578 DOI: 10.7717/peerj.11988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background A feasible and accurate risk prediction systems for emergency department (ED) patients is urgently required. The Modified Early Warning Score (MEWS) is a wide-used tool to predict clinical outcomes in ED. Literatures showed that machine learning (ML) had better predictability in specific patient population than traditional scoring system. By analyzing a large multicenter dataset, we aim to develop a ML model to predict in-hospital morality of the adult non traumatic ED patients for different time stages, and comparing performance with other ML models and MEWS. Methods A retrospective observational cohort study was conducted in five Taiwan EDs including two tertiary medical centers and three regional hospitals. All consecutively adult (>17 years old) non-traumatic patients admit to ED during a 9-year period (January first, 2008 to December 31th, 2016) were included. Exclusion criteria including patients with (1) out-of-hospital cardiac arrest and (2) discharge against medical advice and transferred to other hospital (3) missing collect variables. The primary outcome was in-hospital mortality and were categorized into 6, 24, 72, 168 hours mortality. MEWS was calculated by systolic blood pressure, pulse rate, respiratory rate, body temperature, and level of consciousness. An ensemble supervised stacking ML model was developed and compared to sensitive and unsensitive Xgboost, Random Forest, and Adaboost. We conducted a performance test and examine both the area under the receiver operating characteristic (AUROC) and the area under the precision and recall curve (AUPRC) as the comparative measures. Result After excluding 182,001 visits (7.46%), study group was consisted of 24,37,326 ED visits. The dataset was split into 67% training data and 33% test data for ML model development. There was no statistically difference found in the characteristics between two groups. For the prediction of 6, 24, 72, 168 hours in-hospital mortality, the AUROC of MEW and ML mode was 0.897, 0.865, 0.841, 0.816 and 0.939, 0.928, 0.913, 0.902 respectively. The stacking ML model outperform other ML model as well. For the prediction of in-hospital mortality over 48-hours, AUPRC performance of MEWS drop below 0.1, while the AUPRC of ML mode was 0.317 in 6 hours and 0.2150 in 168 hours. For each time frame, ML model achieved statistically significant higher AUROC and AUPRC than MEWS (all P < 0.001). Both models showed decreasing prediction ability as time elapse, but there was a trend that the gap of AUROC values between two model increases gradually (P < 0.001). Three MEWS thresholds (score >3, >4, and >5) were determined as baselines for comparison, ML mode consistently showed improved or equally performance in sensitivity, PPV, NPV, but not in specific. Conclusion Stacking ML methods improve predicted in-hospital mortality than MEWS in adult non-traumatic ED patients, especially in the prediction of delayed mortality.
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Affiliation(s)
- Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (R.O.C.)
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (R.O.C.)
| | - Hsiang-Ling Tai
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan (R.O.C.)
| | - Jui-Cheng Wang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan (R.O.C.)
| | - Yii-Ting Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (R.O.C.)
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (R.O.C.)
| | - Yun-Nan Chang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan (R.O.C.)
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Dipaola F, Shiffer D, Gatti M, Menè R, Solbiati M, Furlan R. Machine Learning and Syncope Management in the ED: The Future Is Coming. ACTA ACUST UNITED AC 2021; 57:medicina57040351. [PMID: 33917508 PMCID: PMC8067452 DOI: 10.3390/medicina57040351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
In recent years, machine learning (ML) has been promisingly applied in many fields of clinical medicine, both for diagnosis and prognosis prediction. Aims of this narrative review were to summarize the basic concepts of ML applied to clinical medicine and explore its main applications in the emergency department (ED) setting, with a particular focus on syncope management. Through an extensive literature search in PubMed and Embase, we found increasing evidence suggesting that the use of ML algorithms can improve ED triage, diagnosis, and risk stratification of many diseases. However, the lacks of external validation and reliable diagnostic standards currently limit their implementation in clinical practice. Syncope represents a challenging problem for the emergency physician both because its diagnosis is not supported by specific tests and the available prognostic tools proved to be inefficient. ML algorithms have the potential to overcome these limitations and, in the future, they could support the clinician in managing syncope patients more efficiently. However, at present only few studies have addressed this issue, albeit with encouraging results.
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Affiliation(s)
- Franca Dipaola
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.S.); (R.F.)
- Internal Medicine, Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milan, Italy
- Correspondence: ; Tel.: +39-0282247266
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.S.); (R.F.)
| | - Mauro Gatti
- IBM, Active Intelligence Center, 40121 Bologna, Italy;
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Monica Solbiati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.S.); (R.F.)
- Internal Medicine, Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milan, Italy
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Zheng S, Hu X. Early Warning Method for Public Health Emergency Under Artificial Neural Network in the Context of Deep Learning. Front Psychol 2021; 12:594031. [PMID: 33658958 PMCID: PMC7917260 DOI: 10.3389/fpsyg.2021.594031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
The purpose is to minimize the substantial losses caused by public health emergencies to people’s health and daily life and the national economy. The tuberculosis data from June 2017 to 2019 in a city are collected. The Structural Equation Model (SEM) is constructed to determine the relationship between hidden and explicit variables by determining the relevant indicators and parameter estimation. The prediction model based on Artificial Neural Network (ANN) and Convolutional Neural Network (CNN) is constructed. The method’s effectiveness is verified by comparing the prediction model’s loss value and accuracy in training and testing. Meanwhile, 50 pieces of actual cases are tested, and the warning level is determined according to the T-value. The results show that comparing and analyzing ANN, CNN, and the hybrid network of ANN and CNN, the hybrid network’s accuracy (95.1%) is higher than the other two algorithms, 89.1 and 90.1%. Also, the hybrid network has sound prediction effects and accuracy when predicting actual cases. Therefore, the early warning method based on ANN in deep learning has better performance in public health emergencies’ early warning, which is significant for improving early warning capabilities.
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Affiliation(s)
- Shuang Zheng
- College of Media and International Culture, Zhejiang University, Hangzhou, China.,School of Media and Law, NingboTech University, Ningbo, China
| | - Xiaomei Hu
- School of Media and Law, NingboTech University, Ningbo, China
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21
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Muralitharan S, Nelson W, Di S, McGillion M, Devereaux PJ, Barr NG, Petch J. Machine Learning-Based Early Warning Systems for Clinical Deterioration: Systematic Scoping Review. J Med Internet Res 2021; 23:e25187. [PMID: 33538696 PMCID: PMC7892287 DOI: 10.2196/25187] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 01/04/2023] Open
Abstract
Background Timely identification of patients at a high risk of clinical deterioration is key to prioritizing care, allocating resources effectively, and preventing adverse outcomes. Vital signs–based, aggregate-weighted early warning systems are commonly used to predict the risk of outcomes related to cardiorespiratory instability and sepsis, which are strong predictors of poor outcomes and mortality. Machine learning models, which can incorporate trends and capture relationships among parameters that aggregate-weighted models cannot, have recently been showing promising results. Objective This study aimed to identify, summarize, and evaluate the available research, current state of utility, and challenges with machine learning–based early warning systems using vital signs to predict the risk of physiological deterioration in acutely ill patients, across acute and ambulatory care settings. Methods PubMed, CINAHL, Cochrane Library, Web of Science, Embase, and Google Scholar were searched for peer-reviewed, original studies with keywords related to “vital signs,” “clinical deterioration,” and “machine learning.” Included studies used patient vital signs along with demographics and described a machine learning model for predicting an outcome in acute and ambulatory care settings. Data were extracted following PRISMA, TRIPOD, and Cochrane Collaboration guidelines. Results We identified 24 peer-reviewed studies from 417 articles for inclusion; 23 studies were retrospective, while 1 was prospective in nature. Care settings included general wards, intensive care units, emergency departments, step-down units, medical assessment units, postanesthetic wards, and home care. Machine learning models including logistic regression, tree-based methods, kernel-based methods, and neural networks were most commonly used to predict the risk of deterioration. The area under the curve for models ranged from 0.57 to 0.97. Conclusions In studies that compared performance, reported results suggest that machine learning–based early warning systems can achieve greater accuracy than aggregate-weighted early warning systems but several areas for further research were identified. While these models have the potential to provide clinical decision support, there is a need for standardized outcome measures to allow for rigorous evaluation of performance across models. Further research needs to address the interpretability of model outputs by clinicians, clinical efficacy of these systems through prospective study design, and their potential impact in different clinical settings.
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Affiliation(s)
- Sankavi Muralitharan
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada.,DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Walter Nelson
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shuang Di
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael McGillion
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada.,Departments of Health Evidence and Impact and Medicine, McMaster University, Hamilton, ON, Canada
| | - Neil Grant Barr
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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22
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Tang KJW, Ang CKE, Constantinides T, Rajinikanth V, Acharya UR, Cheong KH. Artificial Intelligence and Machine Learning in Emergency Medicine. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Johnsson J, Björnsson O, Andersson P, Jakobsson A, Cronberg T, Lilja G, Friberg H, Hassager C, Kjaergard J, Wise M, Nielsen N, Frigyesi A. Artificial neural networks improve early outcome prediction and risk classification in out-of-hospital cardiac arrest patients admitted to intensive care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:474. [PMID: 32731878 PMCID: PMC7394679 DOI: 10.1186/s13054-020-03103-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023]
Abstract
Background Pre-hospital circumstances, cardiac arrest characteristics, comorbidities and clinical status on admission are strongly associated with outcome after out-of-hospital cardiac arrest (OHCA). Early prediction of outcome may inform prognosis, tailor therapy and help in interpreting the intervention effect in heterogenous clinical trials. This study aimed to create a model for early prediction of outcome by artificial neural networks (ANN) and use this model to investigate intervention effects on classes of illness severity in cardiac arrest patients treated with targeted temperature management (TTM). Methods Using the cohort of the TTM trial, we performed a post hoc analysis of 932 unconscious patients from 36 centres with OHCA of a presumed cardiac cause. The patient outcome was the functional outcome, including survival at 180 days follow-up using a dichotomised Cerebral Performance Category (CPC) scale with good functional outcome defined as CPC 1–2 and poor functional outcome defined as CPC 3–5. Outcome prediction and severity class assignment were performed using a supervised machine learning model based on ANN. Results The outcome was predicted with an area under the receiver operating characteristic curve (AUC) of 0.891 using 54 clinical variables available on admission to hospital, categorised as background, pre-hospital and admission data. Corresponding models using background, pre-hospital or admission variables separately had inferior prediction performance. When comparing the ANN model with a logistic regression-based model on the same cohort, the ANN model performed significantly better (p = 0.029). A simplified ANN model showed promising performance with an AUC above 0.852 when using three variables only: age, time to ROSC and first monitored rhythm. The ANN-stratified analyses showed similar intervention effect of TTM to 33 °C or 36 °C in predefined classes with different risk of a poor outcome. Conclusion A supervised machine learning model using ANN predicted neurological recovery, including survival excellently, and outperformed a conventional model based on logistic regression. Among the data available at the time of hospitalisation, factors related to the pre-hospital setting carried most information. ANN may be used to stratify a heterogenous trial population in risk classes and help determine intervention effects across subgroups.
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Affiliation(s)
- Jesper Johnsson
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Helsingborg Hospital, Lund University, Helsingborg, Sweden. .,Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Charlotte Yléns Gata 10, SE-251 87, Helsingborg, Sweden.
| | - Ola Björnsson
- Centre for Mathematical Sciences, Mathematical Statistics, Lund University, Lund, Sweden.,Department of Energy Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Peder Andersson
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
| | - Andreas Jakobsson
- Centre for Mathematical Sciences, Mathematical Statistics, Lund University, Lund, Sweden
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences Lund, Intensive and Perioperative Care, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet University Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjaergard
- Department of Cardiology, The Heart Centre, Rigshospitalet University Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matt Wise
- Department of Critical Care, University Hospital of Wales, Cardiff, UK
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Attila Frigyesi
- Centre for Mathematical Sciences, Mathematical Statistics, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
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Imai S, Takekuma Y, Kashiwagi H, Miyai T, Kobayashi M, Iseki K, Sugawara M. Validation of the usefulness of artificial neural networks for risk prediction of adverse drug reactions used for individual patients in clinical practice. PLoS One 2020; 15:e0236789. [PMID: 32726360 PMCID: PMC7390378 DOI: 10.1371/journal.pone.0236789] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Artificial neural networks are the main tools for data mining and were inspired by the human brain and nervous system. Studies have demonstrated their usefulness in medicine. However, no studies have used artificial neural networks for the prediction of adverse drug reactions. We aimed to validate the usefulness of artificial neural networks for the prediction of adverse drug reactions and focused on vancomycin -induced nephrotoxicity. For constructing an artificial neural network, a multilayer perceptron algorithm was employed. A 10-fold cross validation method was adopted for evaluating the resultant artificial neural network. In total, 1141 patients who received vancomycin at Hokkaido University Hospital from November 2011 to February 2019 were enrolled. Among these patients, 179 (15.7%) developed vancomycin -induced nephrotoxicity. The top three risk factors of vancomycin -induced nephrotoxicity which are relatively important in the artificial neural networks were average vancomycin trough concentration ≥ 13.0 mg/L and concomitant use of piperacillin–tazobactam and vasopressor drugs. The predictive accuracy of the artificial neural network was 86.3% and that of the multiple logistic regression model (conventional statistical method) was 85.1%. Moreover, area under the receiver operating characteristic curve (AUROC) of the artificial neural network was 0.83. In the 10-fold cross-validation, the accuracy obtained was 86.0% and AUROC was 0.82. The artificial neural network model predicting the vancomycin -induced nephrotoxicity showed good predictive performance. This appears to be the first report of the usefulness of artificial neural networks for an adverse drug reactions risk prediction model.
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Affiliation(s)
- Shungo Imai
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
- * E-mail:
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Hitoshi Kashiwagi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Takayuki Miyai
- Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Masaki Kobayashi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Ken Iseki
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Mitsuru Sugawara
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
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Faita F. Deep learning in Emergency Medicine: Recent contributions and methodological challenges. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.8573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the last few years, artificial intelligence (AI) technology has grown dramatically impacting several fields of human knowledge and medicine in particular. Among other approaches, deep learning, which is a subset of AI based on specific computational models, such as deep convolutional neural networks and recurrent neural networks, has shown exceptional performance in images and signals processing. Accordingly, emergency medicine will benefit from the adoption of this technology. However, a particular attention should be devoted to the review of these papers in order to exclude overoptimistic results from clinically transferable ones. We presented a group of studies recently published on PubMed and selected by keywords ‘deep learning emergency medicine’ and ‘artificial intelligence emergency medicine’ with the aim of highlighting their methodological strengths and weaknesses, as well as their clinical usefulness.
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