Covid-19 triage in the emergency department 2.0: how analytics and AI transform a human-made algorithm for the prediction of clinical pathways

The Covid-19 pandemic has pushed many hospitals to their capacity limits. Therefore, a triage of patients has been discussed controversially primarily through an ethical perspective. The term triage contains many aspects such as urgency of treatment, severity of the disease and pre-existing conditions, access to critical care, or the classification of patients regarding subsequent clinical pathways starting from the emergency department. The determination of the pathways is important not only for patient care, but also for capacity planning in hospitals. We examine the performance of a human-made triage algorithm for clinical pathways which is considered a guideline for emergency departments in Germany based on a large multicenter dataset with over 4,000 European Covid-19 patients from the LEOSS registry. We find an accuracy of 28 percent and approximately 15 percent sensitivity for the ward class. The results serve as a benchmark for our extensions including an additional category of palliative care as a new label, analytics, AI, XAI, and interactive techniques. We find significant potential of analytics and AI in Covid-19 triage regarding accuracy, sensitivity, and other performance metrics whilst our interactive human-AI algorithm shows superior performance with approximately 73 percent accuracy and up to 76 percent sensitivity. The results are independent of the data preparation process regarding the imputation of missing values or grouping of comorbidities. In addition, we find that the consideration of an additional label palliative care does not improve the results

Althoff and the Changing Constitution of Science: Bureaucratic, Economical or Cognitive?

With respect to the guiding “ideas” of Humboldt and their consequences for the constitution of science, describes the transition to a modern research university with the emergence of theory-based practice, science-based technology and technology-based industry. The pure research imperative is endangered or even substituted by a new technological imperativeHistory, Research, Science, Technology, Universities

Grundsatzvernunft und Gelegenheitsvernunft die Prinzipielle Rationalitaet des 'okzidentalen Rationalismus' und die okkasionelle Rationalitaet der 'Moderne': Rationalismusvergleich als interdisziplinaeres theoretisches und empirisches Forschungsprogramm

SIGLEUuStB Koeln(38)-870106311 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekPreprintDEGerman

Max Weber, Carl Schmitt, Bert Brecht als Wegweiser zum ganzen Rationalismus der Doppelvernunft mit einem Anhang: Theorien der Rationalitaet - eine Uebersicht ; oder: ueber die beiden aeussersten Moeglichkeiten, sich in einer irrationalen Welt rational zu orientieren

UuStB Koeln(38)-870106313 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEPreprintDEGerman

Kritik

UuStB Koeln(38)-8306457 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Suspected penicillin allergy: risk assessment using an algorithm as an antibiotic stewardship project

<jats:title>Summary</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Beta-lactam antibiotics (BLA) are the treatment of choice for a large number of bacterial infections. Putative BLA allergies are often reported by patients, but rarely confirmed. Many patients do not receive BLA due to suspected allergy. There is no systematic approach to risk stratification in the case of a history of suspected BLA allergy.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Using the available stratification programs and taking current guidelines into account, an algorithm for risk stratification, including recommendations on the use of antibiotics in cases of compellingly indicated BLA despite suspected BLA allergy, was formulated by the authors for their maximum care university hospital.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The hospital is in great need of recommendations on how to deal with BLA allergies. Patient-reported information in the history forms the basis for classifying the reactions into four risk categories: (1) BLA allergy excluded, (2) benign delayed reaction, (3) immediate reaction, and (4) severe cutaneous and extracutaneous drug reaction. Recommendations strictly depend on this classification and range from use of full-dose BLA or use of BLA under certain conditions (e.g., two-stage dose escalation, non-cross-reactive BLA only) to prohibiting all BLA and the use of alternative non-BLA. In case of suspected immediate or delayed allergic reactions, there is an additional recommendation regarding subsequent allergy testing during a symptom-free interval.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Triage of patients with suspected BLA is urgently required. While allergy testing, including provocation testing, represents the most reliable solution, this is not feasible in all patients due to the high prevalence of BLA allergies. The risk stratification algorithm developed for the authors’ hospital represents a tool suitable to making a contribution to rational antibiotic therapy.</jats:p> </jats:sec&gt