Machine learning models for early sepsis recognition in the neonatal intensive care unit using readily available electronic health record data
| Autor: | Fran Balamuth, Daniel Forsyth, Mary Catherine Harris, Aaron J. Masino, Christopher P. Bonafide, Lakshmi Srinivasan, Svetlana Ostapenko, Melissa Schmatz, Robert W. Grundmeier |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Neonatal intensive care unit Physiology Pathology and Laboratory Medicine computer.software_genre Machine Learning Families 0302 clinical medicine Antibiotics Heart Rate Medicine and Health Sciences Electronic Health Records Medicine Blood culture Diagnosis Computer-Assisted 030212 general & internal medicine Clinical efficacy Children Multidisciplinary Neonatal sepsis medicine.diagnostic_test Antimicrobials Drugs Body Fluids Blood Female Neonatal Sepsis Anatomy Infants Research Article Computer and Information Sciences Critical Care Science Cardiology Machine learning Models Biological Microbiology Sepsis 03 medical and health sciences Signs and Symptoms Diagnostic Medicine Artificial Intelligence Electronic health record Support Vector Machines Microbial Control 030225 pediatrics Humans Retrospective Studies Pharmacology Receiver operating characteristic business.industry Infant Newborn Infant Biology and Life Sciences medicine.disease Age Groups Learning curve People and Places Population Groupings Artificial intelligence business computer |
| Zdroj: | PLoS ONE, Vol 14, Iss 2, p e0212665 (2019) PLoS ONE |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0212665 |
| Popis: | BackgroundRapid antibiotic administration is known to improve sepsis outcomes, however early diagnosis remains challenging due to complex presentation. Our objective was to develop a model using readily available electronic health record (EHR) data capable of recognizing infant sepsis at least 4 hours prior to clinical recognition.Methods and findingsWe performed a retrospective case control study of infants hospitalized ≥48 hours in the Neonatal Intensive Care Unit (NICU) at the Children's Hospital of Philadelphia between September 2014 and November 2017 who received at least one sepsis evaluation before 12 months of age. We considered two evaluation outcomes as cases: culture positive-positive blood culture for a known pathogen (110 evaluations); and clinically positive-negative cultures but antibiotics administered for ≥120 hours (265 evaluations). Case data was taken from the 44-hour window ending 4 hours prior to evaluation. We randomly sampled 1,100 44-hour windows of control data from all times ≥10 days removed from any evaluation. Model inputs consisted of up to 36 features derived from routine EHR data. Using 10-fold nested cross-validation, 8 machine learning models were trained to classify inputs as sepsis positive or negative. When tasked with discriminating culture positive cases from controls, 6 models achieved a mean area under the receiver operating characteristic (AUC) between 0.80-0.82 with no significant differences between them. Including both culture and clinically positive cases, the same 6 models achieved an AUC between 0.85-0.87, again with no significant differences.ConclusionsMachine learning models can identify infants with sepsis in the NICU hours prior to clinical recognition. Learning curves indicate model improvement may be achieved with additional training examples. Additional input features may also improve performance. Further research is warranted to assess potential performance improvements and clinical efficacy in a prospective trial. |
| Databáze: | OpenAIRE |
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