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Seo H, Ahn I, Gwon H, Kang HJ, Kim Y, Cho HN, Choi H, Kim M, Han J, Kee G, Park S, Seo DW, Jun TJ, Kim YH. Prediction of hospitalization and waiting time within 24 hours of emergency department patients with unstructured text data. Health Care Manag Sci 2024; 27:114-129. [PMID: 37921927 PMCID: PMC10896961 DOI: 10.1007/s10729-023-09660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/11/2023] [Indexed: 11/05/2023]
Abstract
Overcrowding of emergency departments is a global concern, leading to numerous negative consequences. This study aimed to develop a useful and inexpensive tool derived from electronic medical records that supports clinical decision-making and can be easily utilized by emergency department physicians. We presented machine learning models that predicted the likelihood of hospitalizations within 24 hours and estimated waiting times. Moreover, we revealed the enhanced performance of these machine learning models compared to existing models by incorporating unstructured text data. Among several evaluated models, the extreme gradient boosting model that incorporated text data yielded the best performance. This model achieved an area under the receiver operating characteristic curve score of 0.922 and an area under the precision-recall curve score of 0.687. The mean absolute error revealed a difference of approximately 3 hours. Using this model, we classified the probability of patients not being admitted within 24 hours as Low, Medium, or High and identified important variables influencing this classification through explainable artificial intelligence. The model results are readily displayed on an electronic dashboard to support the decision-making of emergency department physicians and alleviate overcrowding, thereby resulting in socioeconomic benefits for medical facilities.
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Affiliation(s)
- Hyeram Seo
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Imjin Ahn
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Hansle Gwon
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Hee Jun Kang
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Yunha Kim
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Ha Na Cho
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Heejung Choi
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Minkyoung Kim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Jiye Han
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Gaeun Kee
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Seohyun Park
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Songpagu, Seoul, Korea
| | - Tae Joon Jun
- Big Data Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympicro 43gil, 05505, Songpagu, Seoul, Korea.
| | - Young-Hak Kim
- Division of Cardiology, Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43gil, 05505, Seoul, Songpagu, Korea.
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Chee ML, Chee ML, Huang H, Mazzochi K, Taylor K, Wang H, Feng M, Ho AFW, Siddiqui FJ, Ong MEH, Liu N. Artificial intelligence and machine learning in prehospital emergency care: A scoping review. iScience 2023; 26:107407. [PMID: 37609632 PMCID: PMC10440716 DOI: 10.1016/j.isci.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Our scoping review provides a comprehensive analysis of the landscape of artificial intelligence (AI) applications in prehospital emergency care (PEC). It contributes to the field by highlighting the most studied AI applications and identifying the most common methodological approaches across 106 included studies. The findings indicate a promising future for AI in PEC, with many unique use cases, such as prognostication, demand prediction, resource optimization, and the Internet of Things continuous monitoring systems. Comparisons with other approaches showed AI outperforming clinicians and non-AI algorithms in most cases. However, most studies were internally validated and retrospective, highlighting the need for rigorous prospective validation of AI applications before implementation in clinical settings. We identified knowledge and methodological gaps using an evidence map, offering a roadmap for future investigators. We also discussed the significance of explainable AI for establishing trust in AI systems among clinicians and facilitating real-world validation of AI models.
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Affiliation(s)
- Marcel Lucas Chee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Mark Leonard Chee
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Haotian Huang
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Katelyn Mazzochi
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Kieran Taylor
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Han Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Fahad Javaid Siddiqui
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
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Alghamdi A, Alshibani A, Binhotan M, Alsabani M, Alotaibi T, Alharbi R, Alabdali A. The Ability of Emergency Medical Service Staff to Predict Emergency Department Disposition: A Prospective Study. J Multidiscip Healthc 2023; 16:2101-2107. [PMID: 37525826 PMCID: PMC10387277 DOI: 10.2147/jmdh.s423654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
Purpose Paramedics' decision to notify receiving hospitals and transport patients to an appropriate healthcare facility is based on the Prediction of Intensive Care Unit (ICU) and Hospital Admissions guide. This study aimed to assess the paramedics' gestalt on both ward and ICU admission. Patients and Methods A prospective study was conducted at King Abdulaziz Medical City between September 2021 and March 2022. Paramedics were asked several questions related to the prediction of the patient's hospital outcome, including emergency department (ED) discharge or hospital admission (ICU or ward). Additional data, such as the time of the ambulance's arrival and the staff years of experience, were collected. The categorical characteristics are presented by frequency and percentage for each category. Results This study included 251 paramedics and 251 patients. The average age of the patients was 62 years. Of the patients, 32 (12.7%) were trauma, and 219 (87.3%) were non-trauma patients. Two-thirds of the patients (n=171, 68.1%) were predicted to be admitted to the hospital, and 80 (31.8%) of the EMS staff indicated that the patient do not need a hospital or an ambulance. The sensitivity, specificity, PPV, and NPV of the emergency medical service (EMS) staffs' gestalt for patient admission to the hospital were, respectively (77%), (33%), (16%), and (90%). Further analysis was reported to defend the EMS staffs' gestalt based on the level of EMS staff and the nature of the emergency (medical vs trauma), are reported. Conclusion Our study reports a low level of accurately predicting patient admission to the hospital, including the ICU. The results of this study have important implications for enhancing the accuracy of EMS staff predictive ability and ensuring that patients receive appropriate care promptly.
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Affiliation(s)
- Abdulrhman Alghamdi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alshibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meshary Binhotan
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohmad Alsabani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tareq Alotaibi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rayan Alharbi
- Department of Emergency Medical Service, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah Alabdali
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Lee S, Park HJ, Hwang J, Lee SW, Han KS, Kim WY, Jeong J, Kang H, Kim A, Lee C, Kim SJ. Machine Learning-Based Models for Prediction of Critical Illness at Community, Paramedic, and Hospital Stages. Emerg Med Int 2023; 2023:1221704. [PMID: 37404873 PMCID: PMC10317605 DOI: 10.1155/2023/1221704] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/08/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Overcrowding of emergency department (ED) has put a strain on national healthcare systems and adversely affected the clinical outcomes of critically ill patients. Early identification of critically ill patients prior to ED visits can help induce optimal patient flow and allocate medical resources effectively. This study aims to develop ML-based models for predicting critical illness in the community, paramedic, and hospital stages using Korean National Emergency Department Information System (NEDIS) data. Random forest and light gradient boosting machine (LightGBM) were applied to develop predictive models. The predictive model performance based on AUROC in community stage, paramedic stage, and hospital stage was estimated to be 0.870 (95% CI: 0.869-0.871), 0.897 (95% CI: 0.896-0.898), and 0.950 (95% CI: 0.949-0.950) in random forest and 0.877 (95% CI: 0.876-0.878), 0.899 (95% CI: 0.898-0.900), and 0.950 (95% CI: 0.950-0.951) in LightGBM, respectively. The ML models showed high performance in predicting critical illness using variables available at each stage, which can be helpful in guiding patients to appropriate hospitals according to their severity of illness. Furthermore, a simulation model can be developed for proper allocation of limited medical resources.
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Affiliation(s)
- Sijin Lee
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hyun Ji Park
- Department of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Jumi Hwang
- Department of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jinwoo Jeong
- Department of Emergency Medicine, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Armi Kim
- Department of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Chulung Lee
- School of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
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Liu K, Kotani T, Nakamura K, Chihiro T, Morita Y, Ishii K, Fujizuka K, Yasumura D, Taniguchi D, Hamagami T, Shimojo N, Nitta M, Hongo T, Akieda K, Atsuo M, Kaneko T, Sakuda Y, Andoh K, Nagatomi A, Tanaka Y, Irie Y, Kamijo H, Hanazawa M, Kasugai D, Ayaka M, Oike K, Lefor AK, Takahashi K, Katsukawa H, Ogura T. Effects of evidence-based ICU care on long-term outcomes of patients with sepsis or septic shock (ILOSS): protocol for a multicentre prospective observational cohort study in Japan. BMJ Open 2022; 12:e054478. [PMID: 35351710 PMCID: PMC8961143 DOI: 10.1136/bmjopen-2021-054478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Sepsis is not only the leading cause of death in the intensive care unit (ICU) but also a major risk factor for physical and cognitive impairment and mental disorders, known as postintensive care syndrome (PICS), reduced health-related quality of life (HRQoL) and even mental health disorders in patient families (PICS-family; PICS-F). The ABCDEF bundle is strongly recommended to overcome them, while the association between implementing the bundle and the long-term outcomes is also unknown. METHODS AND ANALYSIS This is a multicentre prospective observational study at 26 ICUs. All consecutive patients between 1 November 2020 and 30 April 2022, who are 18 years old or older and expected to stay in an ICU for more than 48 hours due to sepsis or septic shock, are enrolled. Follow-up to evaluate survival and PICS/ PICS-F will be performed at 3, 6 and 12 months and additionally every 6 months up to 5 years after hospital discharge. Primary outcomes include survival at 12 months, which is the primary outcome, and the incidence of PICS defined as the presence of any physical impairment, cognitive impairment or mental disorders. PICS assessment scores, HRQoL and employment status are evaluated. The association between the implementation rate for the ABCDEF bundle and for each of the individual elements and long-term outcomes will be evaluated. The PICS-F, defined as the presence of mental disorders, and HRQoL of the family is also assessed. Additional analyses with data up to 5 years follow-up are planned. ETHICS AND DISSEMINATION This study received ethics approvals from Saiseikai Utsunomiya Hospital (2020-42) and all other participating institutions and was registered in the University Hospital Medical Information Network Clinical Trials Registry. Informed consent will be obtained from all patients. The findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER UMIN000041433.
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Affiliation(s)
- Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Takai Chihiro
- Department of Emergency Medicine and Critical Care Medicine, Tochigi prefectural emergency and critical care center, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Yasunari Morita
- Department of Emergency and Intensive Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kenzo Ishii
- Department of Anesthesiology, Intensive Care Unit, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Maebashi, Japan
| | - Daisetsu Yasumura
- Department of Rehabilitation, Naha City Hospital, Naha, Okinawa, Japan
| | - Daisuke Taniguchi
- Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Japan
| | - Tomohiro Hamagami
- Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Japan
| | - Nobutake Shimojo
- Emergency and Critical Care Medicine, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Masakazu Nitta
- Department of Intensive Care Unit, Niigata University Medical and Dental Hospital, Niigata, Niigata, Japan
| | - Takashi Hongo
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Kazuki Akieda
- Department of Emergency Medicine, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Japan
| | - Maeda Atsuo
- Department of Emergency and Disaster Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Mie, Japan
| | - Yutaka Sakuda
- Department of Intensive Care Medicine, Okinawa Kyodo Hospital, Naha, Okinawa, Japan
| | - Kohkichi Andoh
- Division of Anesthesiology, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Akiyoshi Nagatomi
- Department of Emergency medicine and Critical Care, St. Marianna University School of Medicine, Yokohama-City Seibu Hospital, Yokohama, Japan
| | - Yukiko Tanaka
- Department of emergency, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuhei Irie
- Department of Emergency and Critical care medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hiroshi Kamijo
- Intensive Care Unit, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Manabu Hanazawa
- Department of Rehabilitation, Japan Red Cross Narita Hospital, Narita, Japan
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine Faculty of Medicine, Nagoya, Aichi, Japan
| | - Matsuoka Ayaka
- Department of Emergency and Critical Care Medicine Faculty, Saga University Hospital, Saga, Saga, Japan
| | - Kenji Oike
- Department of Rehabilitation, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | | | - Kunihiko Takahashi
- M & D Data Science Center, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | | | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi prefectural emergency and critical care center, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
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