Evolution and challenges in the design of computational systems for triage assistance

AbstractCompared with expert systems for specific disease diagnosis, knowledge-based systems to assist decision making in triage usually try to cover a much wider domain but can use a smaller set of variables due to time restrictions, many of them subjective so that accurate models are difficult to build. In this paper, we first study criteria that most affect the performance of systems for triage assistance. Such criteria include whether principled approaches from machine learning can be used to increase accuracy and robustness and to represent uncertainty, whether data and model integration can be performed or whether temporal evolution can be modeled to implement retriage or represent medication responses. Following the most important criteria, we explore current systems and identify some missing features that, if added, may yield to more accurate triage systems

Decision Tree and Random Forest Methodology for Clustered and Longitudinal Binary Outcomes

Clustered binary outcomes are frequently encountered in medical research (e.g. longitudinal studies). Generalized linear mixed models (GLMMs) typically employed for clustered endpoints have challenges for some scenarios (e.g. high dimensional data). In the first dissertation aim, we develop an alternative, data-driven method called Binary Mixed Model (BiMM) tree, which combines decision tree and GLMM. We propose a procedure akin to the expectation maximization algorithm, which iterates between developing a classification and regression tree using all predictors and developing a GLMM which includes indicator variables for terminal nodes from the tree as predictors along with a random effect for the clustering variable. Since prediction accuracy may be increased through ensemble methods, we extend BiMM tree methodology within the random forest setting in the second dissertation aim. BiMM forest combines random forest and GLMM within a unified framework using an algorithmic procedure which iterates between developing a random forest and using the predicted probabilities of observations from the random forest within a GLMM that contains a random effect for the clustering variable. Simulation studies show that BiMM tree and BiMM forest methodology offer similar or superior prediction accuracy compared to standard classification and regression tree, random forest and GLMM for clustered binary outcomes. The new BiMM methods are used to develop prediction models within the acute liver failure setting using the first seven days of hospital data for the third dissertation aim. Acute liver failure is a rare and devastating condition characterized by rapid onset of severe liver damage. The majority of prediction models developed for acute liver failure patients use admission data only, even though many clinical and laboratory variables are collected daily. The novel BiMM tree and forest methodology developed in this dissertation can be used in diverse research settings to provide highly accurate and efficient prediction models for clustered and longitudinal binary outcomes