1,501 research outputs found

    False alarm reduction in critical care

    Get PDF
    High false alarm rates in the ICU decrease quality of care by slowing staff response times while increasing patient delirium through noise pollution. The 2015 PhysioNet/Computing in Cardiology Challenge provides a set of 1250 multi-parameter ICU data segments associated with critical arrhythmia alarms, and challenges the general research community to address the issue of false alarm suppression using all available signals. Each data segment was 5 minutes long (for real time analysis), ending at the time of the alarm. For retrospective analysis, we provided a further 30 seconds of data after the alarm was triggered. A total of 750 data segments were made available for training and 500 were held back for testing. Each alarm was reviewed by expert annotators, at least two of whom agreed that the alarm was either true or false. Challenge participants were invited to submit a complete, working algorithm to distinguish true from false alarms, and received a score based on their program's performance on the hidden test set. This score was based on the percentage of alarms correct, but with a penalty that weights the suppression of true alarms five times more heavily than acceptance of false alarms. We provided three example entries based on well-known, open source signal processing algorithms, to serve as a basis for comparison and as a starting point for participants to develop their own code. A total of 38 teams submitted a total of 215 entries in this year's Challenge. This editorial reviews the background issues for this challenge, the design of the challenge itself, the key achievements, and the follow-up research generated as a result of the Challenge, published in the concurrent special issue of Physiological Measurement. Additionally we make some recommendations for future changes in the field of patient monitoring as a result of the Challenge.National Institutes of Health (U.S.) (Grant R01-GM104987)National Institute of General Medical Sciences (U.S.) (Grant U01-EB-008577)National Institutes of Health (U.S.) (Grant R01-EB-001659

    Single-modal and Multi-modal False Arrhythmia Alarm Reduction using Attention-based Convolutional and Recurrent Neural Networks

    Full text link
    This study proposes a deep learning model that effectively suppresses the false alarms in the intensive care units (ICUs) without ignoring the true alarms using single- and multimodal biosignals. Most of the current work in the literature are either rule-based methods, requiring prior knowledge of arrhythmia analysis to build rules, or classical machine learning approaches, depending on hand-engineered features. In this work, we apply convolutional neural networks to automatically extract time-invariant features, an attention mechanism to put more emphasis on the important regions of the input segmented signal(s) that are more likely to contribute to an alarm, and long short-term memory units to capture the temporal information presented in the signal segments. We trained our method efficiently using a two-step training algorithm (i.e., pre-training and fine-tuning the proposed network) on the dataset provided by the PhysioNet computing in cardiology challenge 2015. The evaluation results demonstrate that the proposed method obtains better results compared to other existing algorithms for the false alarm reduction task in ICUs. The proposed method achieves a sensitivity of 93.88% and a specificity of 92.05% for the alarm classification, considering three different signals. In addition, our experiments for 5 separate alarm types leads significant results, where we just consider a single-lead ECG (e.g., a sensitivity of 90.71%, a specificity of 88.30%, an AUC of 89.51 for alarm type of Ventricular Tachycardia arrhythmia

    Computational approaches to alleviate alarm fatigue in intensive care medicine: A systematic literature review

    Get PDF
    Patient monitoring technology has been used to guide therapy and alert staff when a vital sign leaves a predefined range in the intensive care unit (ICU) for decades. However, large amounts of technically false or clinically irrelevant alarms provoke alarm fatigue in staff leading to desensitisation towards critical alarms. With this systematic review, we are following the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist in order to summarise scientific efforts that aimed to develop IT systems to reduce alarm fatigue in ICUs. 69 peer-reviewed publications were included. The majority of publications targeted the avoidance of technically false alarms, while the remainder focused on prediction of patient deterioration or alarm presentation. The investigated alarm types were mostly associated with heart rate or arrhythmia, followed by arterial blood pressure, oxygen saturation, and respiratory rate. Most publications focused on the development of software solutions, some on wearables, smartphones, or headmounted displays for delivering alarms to staff. The most commonly used statistical models were tree-based. In conclusion, we found strong evidence that alarm fatigue can be alleviated by IT-based solutions. However, future efforts should focus more on the avoidance of clinically non-actionable alarms which could be accelerated by improving the data availability

    Multimodal Signal Processing for Diagnosis of Cardiorespiratory Disorders

    Get PDF
    This thesis addresses the use of multimodal signal processing to develop algorithms for the automated processing of two cardiorespiratory disorders. The aim of the first application of this thesis was to reduce false alarm rate in an intensive care unit. The goal was to detect five critical arrhythmias using processing of multimodal signals including photoplethysmography, arterial blood pressure, Lead II and augmented right arm electrocardiogram (ECG). A hierarchical approach was used to process the signals as well as a custom signal processing technique for each arrhythmia type. Sleep disorders are a prevalent health issue, currently costly and inconvenient to diagnose, as they normally require an overnight hospital stay by the patient. In the second application of this project, we designed automated signal processing algorithms for the diagnosis of sleep apnoea with a main focus on the ECG signal processing. We estimated the ECG-derived respiratory (EDR) signal using different methods: QRS-complex area, principal component analysis (PCA) and kernel PCA. We proposed two algorithms (segmented PCA and approximated PCA) for EDR estimation to enable applying the PCA method to overnight recordings and rectify the computational issues and memory requirement. We compared the EDR information against the chest respiratory effort signals. The performance was evaluated using three automated machine learning algorithms of linear discriminant analysis (LDA), extreme learning machine (ELM) and support vector machine (SVM) on two databases: the MIT PhysioNet database and the St. Vincent’s database. The results showed that the QRS area method for EDR estimation combined with the LDA classifier was the highest performing method and the EDR signals contain respiratory information useful for discriminating sleep apnoea. As a final step, heart rate variability (HRV) and cardiopulmonary coupling (CPC) features were extracted and combined with the EDR features and temporal optimisation techniques were applied. The cross-validation results of the minute-by-minute apnoea classification achieved an accuracy of 89%, a sensitivity of 90%, a specificity of 88%, and an AUC of 0.95 which is comparable to the best results reported in the literature

    Scalable and data efficient deep reinforcement learning methods for healthcare applications

    Get PDF
    2019 Fall.Includes bibliographical references.Artificial intelligence driven medical devices have created the potential for significant breakthroughs in healthcare technology. Healthcare applications using reinforcement learning are still very sparse as the medical domain is very complex and decision making requires domain expertise. High volumes of data generated from medical devices – a key input for delivering on the promise of AI, suffers from both noise and lack of ground truth. The cost of data increases as it is cleaned and annotated. Unlike other data sets, medical data annotation, which is critical for accurate ground truth, requires medical domain expertise for a high-quality patient outcome. While accurate recommendation of decisions is vital in this context, making them in near real-time on devices with computational resource constraint requires that we build efficient, compact representations of models such as deep neural networks. While deeper and wider neural networks are designed for complex healthcare applications, model compression can be an effective way to deploy networks on medical devices that often have hardware and speed constraints. Most state-of-the-art model compression techniques require a resource centric manual process that explores a large model architecture space to find a trade-off solution between model size and accuracy. Recently, reinforcement learning (RL) approaches are proposed to automate such a hand-crafted process. However, most RL model compression algorithms are model-free which require longer time with no assumptions of the model. On the contrary, model-based (MB) approaches are data driven; have faster convergence but are sensitive to the bias in the model. In this work, we report on the use of reinforcement learning to mimic the decision-making process of annotators for medical events, to automate annotation and labelling. The reinforcement agent learns to annotate alarm data based on annotations done by an expert. Our method shows promising results on medical alarm data sets. We trained deep Q-network and advantage actor-critic agents using the data from monitoring devices that are annotated by an expert. Initial results from these RL agents learning the expert-annotated behavior are encouraging and promising. The advantage actor-critic agent performs better in terms of learning the sparse events in a given state, thereby choosing more right actions compared to deep Q-network agent. To the best of our knowledge, this is the first reinforcement learning application for the automation of medical events annotation, which has far-reaching practical use. In addition, a data-driven model-based algorithm is developed, which integrates seamlessly with model-free RL approaches for automation of deep neural network model compression. We evaluate our algorithm on a variety of imaging data from dermoscopy to X-ray on different popular and public model architectures. Compared to model-free RL approaches, our approach achieves faster convergence; exhibits better generalization across different data sets; and preserves comparable model performance. The new RL methods' application to healthcare domain from this work for both false alarm detection and model compression is generic and can be applied to any domain where sequential decision making is partially random and practically controlled by the decision maker
    • …
    corecore