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Cappuccio M, Bianco P, Rotondo M, Spiezia S, D'Ambrosio M, Menegon Tasselli F, Guerra G, Avella P. Current use of artificial intelligence in the diagnosis and management of acute appendicitis. Minerva Surg 2024; 79:326-338. [PMID: 38477067 DOI: 10.23736/s2724-5691.23.10156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Acute appendicitis is a common and time-sensitive surgical emergency, requiring rapid and accurate diagnosis and management to prevent complications. Artificial intelligence (AI) has emerged as a transformative tool in healthcare, offering significant potential to improve the diagnosis and management of acute appendicitis. This review provides an overview of the evolving role of AI in the diagnosis and management of acute appendicitis, highlighting its benefits, challenges, and future perspectives. EVIDENCE ACQUISITION We performed a literature search on articles published from 2018 to September 2023. We included only original articles. EVIDENCE SYNTHESIS Overall, 121 studies were examined. We included 32 studies: 23 studies addressed the diagnosis, five the differentiation between complicated and uncomplicated appendicitis, and 4 studies the management of acute appendicitis. CONCLUSIONS AI is poised to revolutionize the diagnosis and management of acute appendicitis by improving accuracy, speed and consistency. It could potentially reduce healthcare costs. As AI technologies continue to evolve, further research and collaboration are needed to fully realize their potential in the diagnosis and management of acute appendicitis.
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Affiliation(s)
- Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Bianco
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Marco Rotondo
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Salvatore Spiezia
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Marco D'Ambrosio
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Germano Guerra
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Pasquale Avella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy -
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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Prediction of Autonomy Loss in Alzheimer’s Disease. FORECASTING 2021. [DOI: 10.3390/forecast4010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The evolution of functional autonomy loss leads to institutionalization of people affected by Alzheimer’s disease (AD), to an alteration of their quality of life and that of their caregivers. To predict loss of functional autonomy could optimize prevention strategies, aids and cost of care. The aim of this study was to develop and to cross-validate a model to predict loss of functional autonomy as assessed by Instrumental Activities of Daily Living (IADL) score. Outpatients with probable AD and with 2 or more visits to the Clinical and Research Memory Centre of the University Hospital were included. Four Tree-Augmented Naïve bayesian networks (6, 12, 18 and 24 months of follow-up) were built. Variables included in the model were demographic data, IADL score, MMSE score, comorbidities, drug prescription (psychotropics and AD-specific drugs). A 10-fold cross-validation was conducted to evaluate robustness of models. The study initially included 485 patients in the prospective cohort. The best performance after 10-fold cross-validation was obtained with the model able to predict loss of functional autonomy at 18 months (area under the curve of the receiving operator characteristic curve = 0.741, 27% of patients misclassified, positive predictive value = 77% and negative predictive value = 73%). The 13 variables used explain 41.6% of the evolution of functional autonomy at 18 months. A high-performing predictive model of AD evolution of functional autonomy was obtained. An external validation is needed to use the model in clinical routine so as to optimize the patient care.
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Wang KM, Wang KJ, Makond B. Survivability modelling using Bayesian network for patients with first and secondary primary cancers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105686. [PMID: 32777652 DOI: 10.1016/j.cmpb.2020.105686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Multiple primary cancers significantly threat patient survivability. Predicting the survivability of patients with two cancers is challenging because its stochastic pattern relates with numerous variables. METHODS In this study, a Bayesian network (BN) model was proposed to describe the occurrence of two primary cancers and predict the five-year survivability of patients using probabilistic evidence. Eleven types of major primary cancers and contingent occurrences of secondary cancers were investigated. A nationwide two-cancer database involving 7,845 patients in Taiwan was investigated. The BN topology is rigorously examined and imbalanced dataset is processed by the synthetic minority oversampling technique. The proposed BN survivability prognosis model was compared with benchmark approaches. RESULTS The proposed model significantly outperformed the back-propagation neural network, logistic regression, support vector machine, and naïve Bayes in terms of sensitivity, which is a critical performance index for the non-survival group. CONCLUSIONS Using the proposed BN model, one can estimate the posterior probabilities for every query provided appropriate prior evidences. The potential survivability information of patients, treatment effects, and socio-demographics factor effects predicted by the proposed model can help in cancer treatment assessment and cancer development monitoring.
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Affiliation(s)
- Kung-Min Wang
- Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
| | - Kung-Jeng Wang
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, 106, Taiwan, ROC.
| | - Bunjira Makond
- Faculty of Commerce and Management, Prince of Songkla University, Trang, Thailand
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Reddan T, Corness J, Harden F, Hu W, Mengersen K. Bayesian Approach to Predicting Acute Appendicitis Using Ultrasonographic and Clinical Variables in Children. Healthc Inform Res 2019; 25:212-220. [PMID: 31406613 PMCID: PMC6689514 DOI: 10.4258/hir.2019.25.3.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/07/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children. Methods A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes. Results The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation. Conclusions To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Australia.,Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Australia
| | | | - Wenbiao Hu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kerrie Mengersen
- Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
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Dimitrov Y, Ducher M, Kribs M, Laurent G, Richter S, Fauvel JP. Variables linked to hepatitis B vaccination success in non-dialyzed chronic kidney disease patients: Use of a bayesian model. Nephrol Ther 2019; 15:215-219. [PMID: 31129001 DOI: 10.1016/j.nephro.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis B vaccination is recommended for chronic kidney disease (CKD) patients before starting dialysis. We performed an analyis aimed to describe the clinical and biological parameters related to the success of vaccination in CKD patients before starting dialysis. METHODS We extracted data of 170 non-dialyzed patients who were offered hepatitis B vaccination from a register. They received a first vaccination of 40μg followed by boosters after one, two and six months. Patients were considered protected if their hepatitis B antibody level was >10IU/L, three months apart. A logistic regression and a Bayesian model were used to describe the relationships between variables and the success of vaccination. RESULTS Vaccination protected 50.6% of the patients. Model adjustment to the data was higher using the Bayesian model compared to the logistic regression (with area under the ROC curve of 0.955±0.007 vs 0.775±0.066 respectively). The Bayesian model's robustness studied using a 10 fold cross validation showed a percentage of misclassified subjects of 12.4±1.8%, a sensitivity of 87.7±0.3%, a specificity of 87.5±0.3%, a positive predictive value of 87.8±0.3% and negative predictive value of 87.4±0.2%. As classified by the Bayesian model, the variables most related to successful vaccination were, in descending order: age, eGFR, protidemia, albuminemia, cause of renal failure, gender, previous vaccination and weight. CONCLUSION The Bayesian network confirmed that both kidney function and nutritional status of patients are important factors to explain the success of vaccination against hepatitis B in CKD patients before dialysis. For research purposes, before an external validation, the network can be used online at www.hed.cc/?s=Bhepatitis&n=ReseauhepatiteBsup10.neta.
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Affiliation(s)
- Yves Dimitrov
- Nephrology Department, centre hospitalier de Haguenau, 64, avenue du professeur Leriche, 67500 Haguenau, France.
| | - Michel Ducher
- Pharmacy Department, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - Marc Kribs
- Nephrology Department, centre hospitalier de Haguenau, 64, avenue du professeur Leriche, 67500 Haguenau, France
| | - Guillaume Laurent
- Nephrology Department, centre hospitalier de Haguenau, 64, avenue du professeur Leriche, 67500 Haguenau, France
| | | | - Jean-Pierre Fauvel
- Hospices civils de Lyon, université Claude-Bernard Lyon 1, 69000 Lyon, France
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Hafizi-Rastani I, Khalili H, Paydar S, Pourahmad S. Identifying Important Attributes for Prognostic Prediction in Traumatic Brain Injury Patients. Methods Inf Med 2018; 55:440-449. [DOI: 10.3414/me15-01-0080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 05/23/2016] [Indexed: 12/19/2022]
Abstract
SummaryBackground: Generally, traumatic brain injury (TBI) patients do not have a stable condition, particularly after the first week of TBI. Hence, indicating the attributes in prognosis through a prediction model is of utmost importance since it helps caregivers with treatment-decision options, or prepares the relatives for the most-likely outcome. Objectives: This study attempted to determine and order the attributes in prognostic prediction in TBI patients, based on early clinical findings. A hybrid method was employed, which combines a decision tree (DT) and an artificial neural network (ANN) in order to improve the modeling process. Methods: The DT approach was applied as the initial analysis of the network architecture to increase accuracy in prediction. Afterwards, the ANN structure was mapped from the initial DT based on a part of the data. Subsequently, the designed network was trained and validated by the remaining data. 5-fold cross-validation method was applied to train the network. The area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and accuracy rate were utilized as performance measures. The important attributes were then determined from the trained network using two methods: change of mean squared error (MSE), and sensitivity analysis (SA). Results: The hybrid method offered better results compared to the DT method. The accuracy rate of 86.3 % vs. 82.2 %, sensitivity value of 55.1 % vs. 47.6 %, specificity value of 93.6 % vs. 91.1 %, and the area under the ROC curve of 0.705 vs. 0.695 were achieved for the hybrid method and DT, respectively. However, the attributes’ order by DT method was more consistent with the clinical literature. Conclusions: The combination of different modeling methods can enhance their performance. However, it may create some complexities in computations and interpretations. The outcome of the present study could deliver some useful hints in prognostic prediction on the basis of early clinical findings for TBI patients.
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Ducher M, Mounier-Véhier C, Lantelme P, Vaisse B, Baguet JP, Fauvel JP. Reliability of a Bayesian network to predict an elevated aldosterone-to-renin ratio. Arch Cardiovasc Dis 2015; 108:293-9. [DOI: 10.1016/j.acvd.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/04/2014] [Indexed: 01/21/2023]
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Jiménez-Serrano S, Tortajada S, García-Gómez JM. A Mobile Health Application to Predict Postpartum Depression Based on Machine Learning. Telemed J E Health 2015; 21:567-74. [PMID: 25734829 DOI: 10.1089/tmj.2014.0113] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a disorder that often goes undiagnosed. The development of a screening program requires considerable and careful effort, where evidence-based decisions have to be taken in order to obtain an effective test with a high level of sensitivity and an acceptable specificity that is quick to perform, easy to interpret, culturally sensitive, and cost-effective. The purpose of this article is twofold: first, to develop classification models for detecting the risk of PPD during the first week after childbirth, thus enabling early intervention; and second, to develop a mobile health (m-health) application (app) for the Android(®) (Google, Mountain View, CA) platform based on the model with best performance for both mothers who have just given birth and clinicians who want to monitor their patient's test. MATERIALS AND METHODS A set of predictive models for estimating the risk of PPD was trained using machine learning techniques and data about postpartum women collected from seven Spanish hospitals. An internal evaluation was carried out using a hold-out strategy. An easy flowchart and architecture for designing the graphical user interface of the m-health app was followed. RESULTS Naive Bayes showed the best balance between sensitivity and specificity as a predictive model for PPD during the first week after delivery. It was integrated into the clinical decision support system for Android mobile apps. CONCLUSIONS This approach can enable the early prediction and detection of PPD because it fulfills the conditions of an effective screening test with a high level of sensitivity and specificity that is quick to perform, easy to interpret, culturally sensitive, and cost-effective.
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Affiliation(s)
- Santiago Jiménez-Serrano
- 1 Biomedical Informatics Group, Institute for the Applications of Advanced Information and Communication Technologies (ITACA), Polytechnic University of Valencia , Valencia, Spain
| | - Salvador Tortajada
- 1 Biomedical Informatics Group, Institute for the Applications of Advanced Information and Communication Technologies (ITACA), Polytechnic University of Valencia , Valencia, Spain
- 2 Joint Research Unit in Biomedical Engineering-eRPSS (ICT Applied to Healthcare Process Re-engineering), Health Research Institute Hospital La Fe, Valencia , Spain
| | - Juan Miguel García-Gómez
- 1 Biomedical Informatics Group, Institute for the Applications of Advanced Information and Communication Technologies (ITACA), Polytechnic University of Valencia , Valencia, Spain
- 2 Joint Research Unit in Biomedical Engineering-eRPSS (ICT Applied to Healthcare Process Re-engineering), Health Research Institute Hospital La Fe, Valencia , Spain
- 3 Biomedical Imaging Research Group (GIBI230), Health Research Institute Hospital La Fe, Valencia , Spain
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Comparison of a Bayesian network with a logistic regression model to forecast IgA nephropathy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:686150. [PMID: 24328031 PMCID: PMC3847960 DOI: 10.1155/2013/686150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/03/2013] [Accepted: 09/26/2013] [Indexed: 11/21/2022]
Abstract
Models are increasingly used in clinical practice to improve the accuracy of diagnosis. The aim of our work was to compare a Bayesian network to logistic regression to forecast IgA nephropathy (IgAN) from simple clinical and biological criteria. Retrospectively, we pooled the results of all biopsies (n = 155) performed by nephrologists in a specialist clinical facility between 2002 and 2009. Two groups were constituted at random. The first subgroup was used to determine the parameters of the models adjusted to data by logistic regression or Bayesian network, and the second was used to compare the performances of the models using receiver operating characteristics (ROC) curves. IgAN was found (on pathology) in 44 patients. Areas under the ROC curves provided by both methods were highly significant but not different from each other. Based on the highest Youden indices, sensitivity reached (100% versus 67%) and specificity (73% versus 95%) using the Bayesian network and logistic regression, respectively. A Bayesian network is at least as efficient as logistic regression to estimate the probability of a patient suffering IgAN, using simple clinical and biological data obtained during consultation.
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Ludvigsson JF, Pathak J, Murphy S, Durski M, Kirsch PS, Chute CG, Ryu E, Murray JA. Use of computerized algorithm to identify individuals in need of testing for celiac disease. J Am Med Inform Assoc 2013; 20:e306-10. [PMID: 23956016 DOI: 10.1136/amiajnl-2013-001924] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIM Celiac disease (CD) is a lifelong immune-mediated disease with excess mortality. Early diagnosis is important to minimize disease symptoms, complications, and consumption of healthcare resources. Most patients remain undiagnosed. We developed two electronic medical record (EMR)-based algorithms to identify patients at high risk of CD and in need of CD screening. METHODS (I) Using natural language processing (NLP), we searched EMRs for 16 free text (and related) terms in 216 CD patients and 280 controls. (II) EMRs were also searched for ICD9 (International Classification of Disease) codes suggesting an increased risk of CD in 202 patients with CD and 524 controls. For each approach, we determined the optimal number of hits to be assigned as CD cases. To assess performance of these algorithms, sensitivity and specificity were calculated. RESULTS Using two hits as the cut-off, the NLP algorithm identified 72.9% of all celiac patients (sensitivity), and ruled out CD in 89.9% of the controls (specificity). In a representative US population of individuals without a prior celiac diagnosis (assuming that 0.6% had undiagnosed CD), this NLP algorithm could identify a group of individuals where 4.2% would have CD (positive predictive value). ICD9 code search using three hits as the cut-off had a sensitivity of 17.1% and a specificity of 88.5% (positive predictive value was 0.9%). DISCUSSION AND CONCLUSIONS This study shows that computerized EMR-based algorithms can help identify patients at high risk of CD. NLP-based techniques demonstrate higher sensitivity and positive predictive values than algorithms based on ICD9 code searches.
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Bayesian networks: a new method for the modeling of bibliographic knowledge. Med Biol Eng Comput 2013; 51:657-64. [DOI: 10.1007/s11517-013-1035-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 01/06/2013] [Indexed: 11/25/2022]
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Yoldaş Ö, Tez M, Karaca T. Artificial neural networks in the diagnosis of acute appendicitis. Am J Emerg Med 2012; 30:1245-7. [DOI: 10.1016/j.ajem.2011.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/03/2011] [Accepted: 06/03/2011] [Indexed: 11/16/2022] Open
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Tenório JM, Hummel AD, Cohrs FM, Sdepanian VL, Pisa IT, de Fátima Marin H. Artificial intelligence techniques applied to the development of a decision-support system for diagnosing celiac disease. Int J Med Inform 2011; 80:793-802. [PMID: 21917512 DOI: 10.1016/j.ijmedinf.2011.08.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/13/2011] [Accepted: 08/02/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Celiac disease (CD) is a difficult-to-diagnose condition because of its multiple clinical presentations and symptoms shared with other diseases. Gold-standard diagnostic confirmation of suspected CD is achieved by biopsying the small intestine. OBJECTIVE To develop a clinical decision-support system (CDSS) integrated with an automated classifier to recognize CD cases, by selecting from experimental models developed using intelligence artificial techniques. METHODS A web-based system was designed for constructing a retrospective database that included 178 clinical cases for training. Tests were run on 270 automated classifiers available in Weka 3.6.1 using five artificial intelligence techniques, namely decision trees, Bayesian inference, k-nearest neighbor algorithm, support vector machines and artificial neural networks. The parameters evaluated were accuracy, sensitivity, specificity and area under the ROC curve (AUC). AUC was used as a criterion for selecting the CDSS algorithm. A testing database was constructed including 38 clinical CD cases for CDSS evaluation. The diagnoses suggested by CDSS were compared with those made by physicians during patient consultations. RESULTS The most accurate method during the training phase was the averaged one-dependence estimator (AODE) algorithm (a Bayesian classifier), which showed accuracy 80.0%, sensitivity 0.78, specificity 0.80 and AUC 0.84. This classifier was integrated into the web-based decision-support system. The gold-standard validation of CDSS achieved accuracy of 84.2% and k=0.68 (p<0.0001) with good agreement. The same accuracy was achieved in the comparison between the physician's diagnostic impression and the gold standard k=0. 64 (p<0.0001). There was moderate agreement between the physician's diagnostic impression and CDSS k=0.46 (p=0.0008). CONCLUSIONS The study results suggest that CDSS could be used to help in diagnosing CD, since the algorithm tested achieved excellent accuracy in differentiating possible positive from negative CD diagnoses. This study may contribute towards developing of a computer-assisted environment to support CD diagnosis.
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Ting HW, Wu JT, Chan CL, Lin SL, Chen MH. Decision model for acute appendicitis treatment with decision tree technology--a modification of the Alvarado scoring system. J Chin Med Assoc 2010; 73:401-6. [PMID: 20728850 DOI: 10.1016/s1726-4901(10)70087-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 06/29/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND How to decide the proper time to do laparotomies for acute appendicitis patients is sometimes very difficult, especially in areas with no imaging diagnostic tools. The Alvarado scoring system (ASS) is a convenient and inexpensive decision making tool; however, its accuracy needs to be improved. The decision tree is the most frequently used data mining technology for diagnostic model building. This study used a decision tree to modify the ASS and to prioritize the variables. METHODS We collected 532 patients who underwent appendectomy. Patients who had undergone incidental appendectomy were excluded from the study. The decision tree algorithm was constructed with the data mining workbench Clementine version 8.1. It is a top-down algorithm designed to generate a decision tree model with entropy. The algorithm chooses the best decision node with which to separate different classes from empirical data. The Wilcoxon signed rank test, Student t test and chi(2) test were used for statistical analysis. RESULTS Among the 532 patients recruited into the study, 420 had acute appendicitis and 112 had normal appendix. Women with acute appendicitis were older than their male counterparts (p < 0.001). All patients had right lower quadrant tenderness. The new model was constructed with decision tree technology, and the accuracy of the diagnostic rate was better than that of ASS (p < 0.001). The sensitivity and specificity of the new model were 0.945 and 0.805, respectively. CONCLUSION The new model is more convenient and accurate than ASS. Right lower quadrant tenderness is an inclusion criterion for acute appendicitis diagnosis. Migrating pain and neutrophil count > 75% were significant factors for acute appendicitis diagnosis if ASS score < 6. Although the criteria of nausea/vomiting and white blood cell count > 10,000/dL were significantly different between acute appendicitis and normal appendix, there was no significant contribution of entropy change below the "neutrophil count > 75%" nodes in the model. So they were erased from the decision tree model. Further studies need to be conducted to investigate why older women are at higher risk for acute appendicitis.
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Affiliation(s)
- Hsien-Wei Ting
- Department of Neurosurgery, Taipei Hospital, Department of Health, Taipei, Taiwan, R.O.C
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Strylewicz G, Doctor J. Evaluation of an automated method to assist with error detection in the ACCORD central laboratory. Clin Trials 2010; 7:380-9. [DOI: 10.1177/1740774510372779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Errors in clinical laboratory data are rare but their potential high cost both in terms of harm to the subject as well as diluted statistical power results in a significant workload for experts, who must review large volumes of data in the search for these errors. Purpose The current research objective is to develop and evaluate a method to assist in detecting potential errors in laboratory data for an interventional clinical trial, such as Action to Control Cardiovascular Risk in Diabetes, where treatment effects may be influenced by errors in the data. Methods Utilizing data from a clinical trial investigating the effect of intensive glycemic control on major cardiovascular disease events, we constructed an algorithm that conducts probabilistic error detection called a ‘Bayesian network’. Using a synthetic error model, errors were introduced into a testing dataset, and the Bayesian network’s performance in identifying those errors was compared to laboratory experts. For each laboratory result we used the Bayesian network to compute the probability, the measured value was erroneous. This probability was then used to compute a receiver operating characteristic (ROC) curve. Three laboratory experts were recruited and took a survey consisting of 200 laboratory results. The task was to evaluate if these results were erroneous or not and to provide a confidence rating on a 6-point subjective probability scale. Results The Bayesian network’s overall area under the ROC curve was calculated to be 0.79, whereas the three laboratory experts had areas under the ROC curve of 0.73, 0.73, and 0.72. Perfect error prediction and random guessing yield a ROC of 1.00 and 0.50, respectively. This difference in performance was statistically significant for all three experts. Human experts were also generally overconfident in their ability to detect errors. Limitations The model is, by design, specific to a novel intervention in a specific diabetic population and, therefore, the specific Bayesian network discussed may not generalize to other interventions and populations. In addition, the study is limited by the small number of expert eligible to complete the survey. Conclusions The results of this study suggest that continuous Bayesian networks, suitably constructed, may serve as an effective tool to assist experts in the review of voluminous laboratory data by flagging unlikely results for more thorough review. Clinical Trials 2010; 7: 380—389. http://ctj.sagepub.com
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Affiliation(s)
- Gregory Strylewicz
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA, USA,
| | - Jason Doctor
- Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California, Los Angeles, CA, USA
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Himes BE, Wu AC, Duan QL, Klanderman B, Litonjua AA, Tantisira K, Ramoni MF, Weiss ST. Predicting response to short-acting bronchodilator medication using Bayesian networks. Pharmacogenomics 2009; 10:1393-412. [PMID: 19761364 DOI: 10.2217/pgs.09.93] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Bronchodilator response tests measure the effect of beta(2)-agonists, the most commonly used short-acting reliever drugs for asthma. We sought to relate candidate gene SNP data with bronchodilator response and measure the predictive accuracy of a model constructed with genetic variants. MATERIALS & METHODS Bayesian networks, multivariate models that are able to account for simultaneous associations and interactions among variables, were used to create a predictive model of bronchodilator response using candidate gene SNP data from 308 Childhood Asthma Management Program Caucasian subjects. RESULTS The model found that 15 SNPs in 15 genes predict bronchodilator response with fair accuracy, as established by a fivefold cross-validation area under the receiver-operating characteristic curve of 0.75 (standard error: 0.03). CONCLUSION Bayesian networks are an attractive approach to analyze large-scale pharmacogenetic SNP data because of their ability to automatically learn complex models that can be used for the prediction and discovery of novel biological hypotheses.
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Affiliation(s)
- Blanca E Himes
- Harvard-MIT Division of Health Sciences and Technology, MA, USA.
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Himes BE, Dai Y, Kohane IS, Weiss ST, Ramoni MF. Prediction of chronic obstructive pulmonary disease (COPD) in asthma patients using electronic medical records. J Am Med Inform Assoc 2009; 16:371-9. [PMID: 19261943 PMCID: PMC2732240 DOI: 10.1197/jamia.m2846] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Accepted: 01/30/2009] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Identify clinical factors that modulate the risk of progression to COPD among asthma patients using data extracted from electronic medical records. DESIGN Demographic information and comorbidities from adult asthma patients who were observed for at least 5 years with initial observation dates between 1988 and 1998, were extracted from electronic medical records of the Partners Healthcare System using tools of the National Center for Biomedical Computing "Informatics for Integrating Biology to the Bedside" (i2b2). MEASUREMENTS A predictive model of COPD was constructed from a set of 9,349 patients (843 cases, 8,506 controls) using Bayesian networks. The model's predictive accuracy was tested using it to predict COPD in a future independent set of asthma patients (992 patients; 46 cases, 946 controls), who had initial observation dates between 1999 and 2002. RESULTS A Bayesian network model composed of age, sex, race, smoking history, and 8 comorbidity variables is able to predict COPD in the independent set of patients with an accuracy of 83.3%, computed as the area under the Receiver Operating Characteristic curve (AUROC). CONCLUSIONS Our results demonstrate that data extracted from electronic medical records can be used to create predictive models. With improvements in data extraction and inclusion of more variables, such models may prove to be clinically useful.
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Affiliation(s)
- Blanca E Himes
- Channing Laboratory, 181 Longwood Ave, Boston, MA 02115, USA.
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