An artificial intelligence system for predicting the deterioration of COVID-19 patients in the emergency department
Farah E. Shamout, Yiqiu Shen, Nan Wu, Aakash Kaku, Jungkyu Park, Taro Makino, Stanisław Jastrzębski, Jan Witowski, Duo Wang, Ben Zhang, Siddhant Dogra, Meng Cao… 展开作者
Farah E. Shamout, Yiqiu Shen, Nan Wu, Aakash Kaku, Jungkyu Park, Taro Makino, Stanisław Jastrzębski, Jan Witowski, Duo Wang, Ben Zhang, Siddhant Dogra, Meng Cao, Narges Razavian, David Kudlowitz, Lea Azour, William Moore, Yvonne W. Lui, Yindalon Aphinyanaphongs, Carlos Fernandez-Granda, Krzysztof J. Geras
During the coronavirus disease 2019 (COVID-19) pandemic, rapid and accurate triage of patients at the emergency department is critical to inform decision-making. We propose a data-driven approach for automatic prediction of deterioration risk using a deep neural network that learns from chest X-ray images and a gradient boosting model that learns from routine clinical variables. Our AI prognosis system, trained using data from 3,661 patients, achieves an area under the receiver operating characteristic curve (AUC) of 0.786 (95% CI: 0.745-0.830) when predicting deterioration within 96 hours. The deep neural network extracts informative areas of chest X-ray images to assist clinicians in interpreting the predictions and performs comparably to two radiologists in a reader study. In order to verify performance in a real clinical setting, we silently deployed a preliminary version of the deep neural network at New York University Langone Health during the first wave of the pandemic, which produced accurate predictions in real-time. In summary, our findings demonstrate the potential of the proposed system for assisting front-line physicians in the triage of COVID-19 patients.
KenSci Inc（KenSci公司）；University of Washington（华盛顿大学）；Swedish Medical Center（瑞典医疗中心）；University of Washington - Bothell（华盛顿大学博塞尔分校）；University of Washington - Tacoma（华盛顿大学塔科马分校）
Over the past several years, across the globe, there has been an increase in people seeking care in emergency departments (EDs). ED resources, including nurse staffing, are strained by such increases in patient volume. Accurate forecasting of incoming patient volume in emergency departments (ED) is crucial for efficient utilization and allocation of ED resources. Working with a suburban ED in the Pacific Northwest, we developed a tool powered by machine learning models, to forecast ED arrivals and ED patient volume to assist end-users, such as ED nurses, in resource allocation. In this paper, …
Parkland Center for Clinical Innovation (PCCI)（帕克兰临床创新中心）；Parkland Community Health Plan (PCHP)（帕克兰社区健康计划）
Pediatric asthma is the most prevalent chronic childhood illness, afflicting about 6.2 million children in the United States. However, asthma could be better managed by identifying and avoiding triggers, educating about medications and proper disease management strategies. This research utilizes deep learning methodologies to predict asthma-related emergency department (ED) visit within 3 months using Medicaid claims data. We compare prediction results against traditional statistical classification model - penalized Lasso logistic regression, which we trained and have deployed since 2015. The …
Predicting patient volumes in a hospital setting is a well-studied application of time series forecasting. Existing tools usually make forecasts at the daily or weekly level to assist in planning for staffing requirements. Prompted by new COVID-related capacity constraints placed on our pediatric hospital's emergency department, we developed an hourly forecasting tool to make predictions over a 24 hour window. These forecasts would give our hospital sufficient time to be able to martial resources towards expanding capacity and augmenting staff (e.g. transforming wards or bringing in physicians…
In the United States, medical responses by fire departments over the last four decades increased by 367%. This had made it critical to decision makers in emergency response departments that existing resources are efficiently used. In this paper, we model the ambulance dispatch problem as an average-cost Markov decision process and present a policy iteration approach to find an optimal dispatch policy. We then propose an alternative formulation using post-decision states that is shown to be mathematically equivalent to the original model, but with a much smaller state space. We present a tempor…
Development and Comparative Evaluation of Three Artificial Intelligence Models (NLP, LLM, JEPA) for Predicting Triage in Emergency Departments: A 7-Month Retrospective Proof-of-Concept
Department of Emergency Lille University Hospital（里尔大学医院急诊科）；Centre Antipoison, Lille University Hospital（里尔大学医院毒物中心）；Department of Public Health, EA 2694 & ULR 2694-METRICS（公共卫生部门，EA 2694及ULR 2694-METRICS）；Lille University（里尔大学）；Emergency Department Hôpital Pitié-Salpêtrière, AP-HP（皮蒂埃-萨尔佩特里耶医院急诊科，AP-HP）
State University of New York at Binghamton（纽约州立大学宾汉姆顿分校）
Recently, the combination of machine learning (ML) and simulation is gaining a lot of attention. This paper presents a novel application of ML within the simulation to improve patient flow within an emergency department (ED). An ML model used within a real ED simulation model to quantify the effect of detouring a patient out of the ED on the length of stay (LOS) and door-to-doctor time (DTDT) as a response to the prediction of patient admission to the hospital from the ED. The ML model trained using a set of six features including the patient age, arrival day, arrival hour of the day, and the …
Hellenic Open University（希腊开放大学）；Sismanogleio General Hospital（西斯马诺格利奥综合医院）；Thoracic Diseases General Hospital Sotiria（索提里亚胸科疾病综合医院）；National and Kapodistrian University of Athens（雅典国家与卡波迪斯特里安大学）
Introduction: One of the most important tasks in the Emergency Department (ED) is to promptly identify the patients who will benefit from hospital admission. Machine Learning (ML) techniques show promise as diagnostic aids in healthcare. Material and methods: We investigated the following features seeking to investigate their performance in predicting hospital admission: serum levels of Urea, Creatinine, Lactate Dehydrogenase, Creatine Kinase, C-Reactive Protein, Complete Blood Count with differential, Activated Partial Thromboplastin Time, D Dimer, International Normalized Ratio, age, gender,…
Development of a Large Language Model-based Multi-Agent Clinical Decision Support System for Korean Triage and Acuity Scale (KTAS)-Based Triage and Treatment Planning in Emergency Departments
John Bapst Memorial High School（约翰·巴普斯特纪念高中）；Minerva University（密涅瓦大学）
Chemical Mass Casualty Incidents (MCI) place a heavy burden on hospital staff and resources. Machine Learning (ML) tools can provide efficient decision support to caregivers. However, ML models require large volumes of data for the most accurate results, which is typically not feasible in the chaotic nature of a chemical MCI. This study examines the application of four statistical dimension reduction techniques: Random Selection, Covariance/Variance, Pearson's Linear Correlation, and Principle Component Analysis to reduce a dataset of 311 hazardous chemicals and 79 related signs and symptoms (…
Validating Emergency Department Admission Predictions Based on Local Data Through MIMIC-IV
Hellenic Open University（希腊开放大学）；Sismanogleio General Hospital（西斯马诺格利奥综合医院）；National and Kapodistrian University of Athens（雅典国立卡波迪斯特里亚大学）；Amalia Fleming General Hospital（阿玛利亚·弗莱明综合医院）
Forecasting mortality associated emergency department crowding
Faculty of Medicine and Health Technology, Tampere University（坦佩雷大学医学与健康技术学院）；Emergency Department, Tampere University Hospital（坦佩雷大学医院急诊科）；Kanta-Häme Central Hospital（坎塔-海梅中心医院）；Faculty of Information Technology and Communication Sciences, Tampere University（坦佩雷大学信息技术与传播科学学院）；Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital（坦佩雷大学医院血管外科与介入放射中心）
Temple University（天普大学）；Lewis Katz School of Medicine, Temple University（天普大学刘易斯·卡茨医学院）
Optimization of patient throughput and wait time in emergency departments (ED) is an important task for hospital systems. For that reason, Emergency Severity Index (ESI) system for patient triage was introduced to help guide manual estimation of acuity levels, which is used by nurses to rank the patients and organize hospital resources. However, despite improvements that it brought to managing medical resources, such triage system greatly depends on nurse's subjective judgment and is thus prone to human errors. Here, we propose a novel deep model based on the word attention mechanism designed …
Benchmarking emergency department triage prediction models with machine learning and large public electronic health records
Duke-NUS Medical School（杜克-新加坡国立大学医学院）；Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR)（新加坡科技研究局高性能计算研究所）；Nanyang Technological University（南洋理工大学）；Monash University（莫纳什大学）；National University of Singapore（新加坡国立大学）；Duke University（杜克大学）；Beth Israel Deaconess Medical Center（贝斯以色列女执事医疗中心）；Harvard Medical School（哈佛医学院）；Massachusetts Institute of Technology（麻省理工学院）；Singapore General Hospital（新加坡中央医院）；Singapore Health Services（新加坡保健服务集团）
MRC Centre for Global Infectious Disease Analysis, Imperial College London（帝国理工学院MRC全球传染病分析中心）；Imperial College Healthcare NHS Trust（帝国理工学院医疗保健国民健康服务体系信托）；Faculty of Medicine, Imperial College London（帝国理工学院医学院）；Department of Infectious Disease, Imperial College London（帝国理工学院传染病系）；Department of Mathematics, Imperial College London（帝国理工学院数学系）
There were 25.6 million attendances at Emergency Departments (EDs) in England in 2019 corresponding to an increase of 12 million attendances over the past ten years. The steadily rising demand at EDs creates a constant challenge to provide adequate quality of care while maintaining standards and productivity. Managing hospital demand effectively requires an adequate knowledge of the future rate of admission. Using 8 years of electronic admissions data from two major acute care hospitals in London, we develop a novel ensemble methodology that combines the outcomes of the best performing time se…
Multi-Modal Perceiver Language Model for Outcome Prediction in Emergency Department
Qatar Computing Research Institute（卡塔尔计算研究所）；Hamad Bin Khalifa University（哈马德·本·哈利法大学）；LIMTIC Laboratory（LIMTIC实验室）；UTM University（突尼斯马纳大学）；Higher institute of computer science of Medenine（梅德宁高等计算机科学学院）；Gabes University（加贝斯大学）；Sidra Medicine（锡德拉医学中心）
An Integrated Forecasting Prototype for Emergency Department Boarding Time to Support Proactive Operational Decision Making
Department of Electrical and Computer Engineering, University of Alabama at Birmingham（阿拉巴马大学伯明翰分校电气与计算机工程系）；Department of Health Services Administration, University of Alabama at Birmingham（阿拉巴马大学伯明翰分校卫生服务管理系）；Department of Biomedical Informatics and Data Science, Heersink School of Medicine, University of Alabama at Birmingham（阿拉巴马大学伯明翰分校希尔斯医院医学院生物医学信息学与数据科学系）；Department of Emergency Medicine, University of Alabama at Birmingham（阿拉巴马大学伯明翰分校急诊医学系）
Analyzing the Variations in Emergency Department Boarding and Testing the Transferability of Forecasting Models across COVID-19 Pandemic Waves in Hong Kong: Hybrid CNN-LSTM approach to quantifying building-level socioecological risk
JC School of Public Health and Primary Care, The Chinese University of Hong Kong（香港中文大学赛马会公共卫生及基层医疗学院）；Hong Kong Polytechnic University（香港理工大学）
Graz University of Technology（格拉茨工业大学）；University of Auckland（奥克兰大学）；Technical University of Darmstadt（达姆施塔特工业大学）
The performance of Emergency Departments (EDs) is of great importance for any health care system, as they serve as the entry point for many patients. However, among other factors, the variability of patient acuity levels and corresponding treatment requirements of patients visiting EDs imposes significant challenges on decision makers. Balancing waiting times of patients to be first seen by a physician with the overall length of stay over all acuity levels is crucial to maintain an acceptable level of operational performance for all patients. To address those requirements when assigning idle r…
Texas A&M University（德克萨斯农工大学）；Yale School of Medicine（耶鲁医学院）
Visual summarization of clinical data collected on patients contained within the electronic health record (EHR) may enable precise and rapid triage at the time of patient presentation to an emergency department (ED). The triage process is critical in the appropriate allocation of resources and in anticipating eventual patient disposition, typically admission to the hospital or discharge home. EHR data are high-dimensional and complex, but offer the opportunity to discover and characterize underlying data-driven patient phenotypes. These phenotypes will enable improved, personalized therapeutic…
ED-Copilot: Reduce Emergency Department Wait Time with Language Model Diagnostic Assistance
Language Technologies Institute, Carnegie Mellon University（卡内基梅隆大学语言技术研究所）；University of California, Berkeley（加州大学伯克利分校）；University of California, San Francisco（加州大学旧金山分校）；Department of EECS, University of California, Berkeley（加州大学伯克利分校电子工程与计算机科学系）
The Ohio State University（俄亥俄州立大学）；The Abigail Wexner Research Institute at Nationwide Children’s Hospital（全国儿童医院阿比盖尔·韦克斯纳研究所）
Trauma mortality results from a multitude of non-linear dependent risk factors including patient demographics, injury characteristics, medical care provided, and characteristics of medical facilities; yet traditional approach attempted to capture these relationships using rigid regression models. We hypothesized that a transfer learning based machine learning algorithm could deeply understand a trauma patient's condition and accurately identify individuals at high risk for mortality without relying on restrictive regression model criteria. Anonymous patient visit data were obtained from years …
Considering Spatial Structure of the Road Network in Pavement Deterioration Modeling
Department of Civil and Environmental Engineering, University of Houston（休斯顿大学土木与环境工程系）；School of Computing and Information, University of Pittsburgh（匹兹堡大学计算与信息学院）；College of Business, North Dakota State University（北达科他州立大学商学院）
Effective Predictive Modeling for Emergency Department Visits and Evaluating Exogenous Variables Impact: Using Explainable Meta-learning Gradient Boosting
Canberra Health Services, Canberra Hospital（堪培拉卫生服务局，堪培拉医院）；University of Technology Sydney（悉尼科技大学）；University of New South Wales（新南威尔士大学）；The Australian National University（澳大利亚国立大学）；Obuda University（欧布达大学）
Mednition Inc.（Mednition公司）；Emergency Nurses Association（急诊护士协会）；El Camino Hospital（埃尔卡米诺医院）；San Mateo Medical Center（圣马特奥医疗中心）；Adventist Health White Memorial（复临健康怀特纪念医院）；Ascension Health（阿森松医疗）；American Osteopathic Association（美国骨科协会）
Effective triage is critical to mitigating the effect of increased volume by accurately determining patient acuity, need for resources, and establishing effective acuity-based patient prioritization. The purpose of this retrospective study was to determine whether historical EHR data can be extracted and synthesized with clinical natural language processing (C-NLP) and the latest ML algorithms (KATE) to produce highly accurate ESI predictive models. An ML model (KATE) for the triage process was developed using 166,175 patient encounters from two participating hospitals. The model was then test…
Detection of sepsis during emergency department triage using machine learning
Mednition Inc.（麦迪逊公司）；Sutter Mills-Peninsula Medical Center（萨特米尔半岛医疗中心）；Ascension Health（阿森松医疗）；Adventist Health White Memorial（基督复临安息日会怀特纪念医疗中心）；San Mateo Medical Center（圣马特奥医疗中心）；El Camino Hospital（埃尔卡米诺医院）；Emergency Nurses Association（急诊护士协会）；Duke University（杜克大学）
Facebook AI Research（脸书人工智能研究院）；NYU Abu Dhabi（纽约大学阿布扎比分校）；NYU School of Medicine（纽约大学医学院）
The rapid spread of COVID-19 cases in recent months has strained hospital resources, making rapid and accurate triage of patients presenting to emergency departments a necessity. Machine learning techniques using clinical data such as chest X-rays have been used to predict which patients are most at risk of deterioration. We consider the task of predicting two types of patient deterioration based on chest X-rays: adverse event deterioration (i.e., transfer to the intensive care unit, intubation, or mortality) and increased oxygen requirements beyond 6 L per day. Due to the relative scarcity of…
Delirium is a common acute onset brain dysfunction in the emergency setting and is associated with higher mortality. It is difficult to detect and monitor since its presentations and risk factors can be different depending on the underlying medical condition of patients. In our study, we aimed to identify subtypes within the delirium population and build subgroup-specific predictive models to detect delirium using Medical Information Mart for Intensive Care IV (MIMIC-IV) data. We showed that clusters exist within the delirium population. Differences in feature importance were also observed for…
The University of Alabama at Birmingham（阿拉巴马大学伯明翰分校）；The Pennsylvania State University（宾夕法尼亚州立大学）；Auburn University（奥本大学）
This work proposes a framework for optimizing machine learning algorithms. The practicality of the framework is illustrated using an important case study from the healthcare domain, which is predicting the admission status of emergency department (ED) patients (e.g., admitted vs. discharged) using patient data at the time of triage. The proposed framework can mitigate the crowding problem by proactively planning the patient boarding process. A large retrospective dataset of patient records is obtained from the electronic health record database of all ED visits over three years from three major…
Early Warning Index for Patient Deteriorations in Hospitals
Sloan School of Management, Massachusetts Institute of Technology（麻省理工学院斯隆管理学院）；Operations and Information Management, University of Wisconsin Madison（威斯康星大学麦迪逊分校运营与信息管理系）；Technology Management and Innovation, New York University（纽约大学技术管理与创新系）；Hartford HealthCare（哈特福德医疗集团）；Holistic Hospital Optimization（综合医院优化）
In 2019, the entire world is facing a situation of health emergency due to a newly emerged coronavirus (COVID-19). Almost 196 countries are affected by covid-19, while USA, Italy, China, Spain, Iran, and France have the maximum active cases of COVID-19. The issues, medical and healthcare departments are facing in delay of detecting the COVID-19. Several artificial intelligence based system are designed for the automatic detection of COVID-19 using chest x-rays. In this article we will discuss the different approaches used for the detection of COVID-19 and the challenges we are facing. It is ma…
Centers for Disease Control and Prevention（美国疾病控制与预防中心）；Sandia National Laboratories（桑迪亚国家实验室）
Syndromic surveillance detects and monitors individual and population health indicators through sources such as emergency department records. Automated classification of these records can improve outbreak detection speed and diagnosis accuracy. Current syndromic systems rely on hand-coded keyword-based methods to parse written fields and may benefit from the use of modern supervised-learning classifier models. In this paper we implement two recurrent neural network models based on long short-term memory (LSTM) and gated recurrent unit (GRU) cells and compare them to two traditional bag-of-word…
Austrian Research Institute for Artificial Intelligence（奥地利人工智能研究院）；University of Manchester（曼彻斯特大学）
Despite of the pain and limited accuracy of blood tests for early recognition of cardiovascular disease, they dominate risk screening and triage. On the other hand, heart rate variability is non-invasive and cheap, but not considered accurate enough for clinical practice. Here, we tackle heart beat interval based classification with deep learning. We introduce an end to end differentiable hybrid architecture, consisting of a layer of biological neuron models of cardiac dynamics (modified FitzHugh Nagumo neurons) and several layers of a standard feed-forward neural network. The proposed model i…
University of Oxford（牛津大学）；Oxford University Hospitals Trust（牛津大学医院信托）
Accurate and reliable prediction of hospital admission location is important due to resource-constraints and space availability in a clinical setting, particularly when dealing with patients who come from the emergency department. In this work we propose a student-teacher network via reinforcement learning to deal with this specific problem. A representation of the weights of the student network is treated as the state and is fed as an input to the teacher network. The teacher network's action is to select the most appropriate batch of data to train the student network on from a training set s…
