论文标题

急诊室护理期间创伤患者结果预测的机器智能

Machine Intelligence for Outcome Predictions of Trauma Patients During Emergency Department Care

论文作者

Cardosi, Joshua D., Shen, Herman, Groner, Jonathan I., Armstrong, Megan, Xiang, Henry

论文摘要

创伤死亡率来自多种非线性依赖性风险因素,包括患者人口统计,受伤特征,提供的医疗服务以及医疗机构的特征;然而,传统方法试图使用刚性回归模型捕获这些关系。我们假设基于转移学习的机器学习算法可以深入了解创伤患者的状况,并准确地识别出死亡率高的人而不依赖限制性回归模型标准。匿名患者访问数据是从2007 - 2014年开始的国家创伤数据库获得的。排除了不完全的生命力,未知结果或缺失人口统计数据的患者。所有患者就诊都发生在美国医院,在回顾性检查的2,007,485次遭遇中,有8,198例导致死亡率(0.4%)。评估了机器智能模型的灵敏度,特异性,正面和负预测值,以及Matthews相关系数。我们的模型在特定年龄的比较模型中达到了相似的性能,同时应用于所有年龄段时,良好的表现良好。在测试混杂因素的同时,我们发现不包括与跌倒有关的伤害增加了成人创伤患者的表现。但是,它降低了儿童的表现。此处描述的机器智能模型表现出与当代机器智能模型相似的性能,而无需限制性回归模型标准或广泛的医学专业知识。

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 2007-2014 of the National Trauma Data Bank. Patients with incomplete vitals, unknown outcome, or missing demographics data were excluded. All patient visits occurred in U.S. hospitals, and of the 2,007,485 encounters that were retrospectively examined, 8,198 resulted in mortality (0.4%). The machine intelligence model was evaluated on its sensitivity, specificity, positive and negative predictive value, and Matthews Correlation Coefficient. Our model achieved similar performance in age-specific comparison models and generalized well when applied to all ages simultaneously. While testing for confounding factors, we discovered that excluding fall-related injuries boosted performance for adult trauma patients; however, it reduced performance for children. The machine intelligence model described here demonstrates similar performance to contemporary machine intelligence models without requiring restrictive regression model criteria or extensive medical expertise.

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