Detecting Hazardous Intensive Care Patient Episodes Using Real-time Mortality Models

PhD thesisThe modern intensive care unit (ICU) has become a complex, expensive, data-intensive environment. Caregivers maintain an overall assessment of their patients based on important observations and trends. If an advanced monitoring system could also reliably provide a systemic interpretation of a patient's observations it could help caregivers interpret these data more rapidly and perhaps more accurately. In this thesis I use retrospective analysis of mixed medical/surgical intensive care patients to develop predictive models. Logistic regression is applied to 7048 development patients with several hundred candidate variables. These candidate variables range from simple vitals to long term trends and baseline deviations. Final models are selected by backward elimination on top cross-validated variables and validated on 3018 additional patients. The real-time acuity score (RAS) that I develop demonstrates strong discrimination ability for patient mortality, with an ROC area (AUC) of 0.880. The final model includes a number of variables known to be associated with mortality, but also computationally intensive variables absent in other severity scores. In addition to RAS, I also develop secondary outcome models that perform well at predicting pressor weaning (AUC=0.825), intraaortic balloon pump removal (AUC=0.816), the onset of septic shock (AUC=0.843), and acute kidney injury (AUC=0.742). Real-time mortality prediction is a feasible way to provide continuous risk assessment for ICU patients. RAS offers similar discrimination ability when compared to models computed once per day, based on aggregate data over that day. Moreover, RAS mortality predictions are better at discrimination than a customized SAPS II score (Day 3 AUC=0.878 vs AUC=0.849, p < 0.05). The secondary outcome models also provide interesting insights into patient responses to care and patient risk profiles. While models trained for specifically recognizing secondary outcomes consistently outperform the RAS model at their specific tasks, RAS provides useful baseline risk estimates throughout these events and in some cases offers a notable level of predictive utility.Ph.D. in Computer Scienc

Predicting the risk and trajectory of intensive care patients using survival models

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2006.Includes bibliographical references (p. 119-126).Using artificial intelligence to assist physicians in patient care has received sustained interest over the past several decades. Recently, with automated systems at most bedsides, the amount of patient information collected continues to increase, providing specific impetus for intelligent systems that can interpret this information. In fact, the large set of sensors and test results, often measured repeatedly over long periods of time, make it challenging for caregivers to quickly utilize all of the data for optimal patient treatment. This research focuses on predicting the survival of ICU patients throughout their stay. Unlike traditional static mortality models, this survival prediction is explored as an indicator of patient state and trajectory. Using survival analysis techniques and machine learning, models are constructed that predict individual patient survival probabilities at fixed intervals in the future. These models seek to help physicians interpret the large amount of data available in order to provide optimal patient care. We find that the survival predictions from our models are comparable to survival predictions using the SAPS score, but are available throughout the patient's ICU course instead of only at 24 hours after admission. Additionally, we demonstrate effective prediction of patient mortality over fixed windows in the future.by Caleb W. Hug.S.M

Detecting hazardous intensive care patient episodes using real-time mortality models

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2009.Cataloged from PDF version of thesis.Includes bibliographical references (p. 229-237).The modern intensive care unit (ICU) has become a complex, expensive, data-intensive environment. Caregivers maintain an overall assessment of their patients based on important observations and trends. If an advanced monitoring system could also reliably provide a systemic interpretation of a patient's observations it could help caregivers interpret these data more rapidly and perhaps more accurately. In this thesis I use retrospective analysis of mixed medical/surgical intensive care patients to develop predictive models. Logistic regression is applied to 7048 development patients with several hundred candidate variables. These candidate variables range from simple vitals to long term trends and baseline deviations. Final models are selected by backward elimination on top cross-validated variables and validated on 3018 additional patients. The real-time acuity score (RAS) that I develop demonstrates strong discrimination ability for patient mortality, with an ROC area (AUC) of 0.880. The final model includes a number of variables known to be associated with mortality, but also computationally intensive variables absent in other severity scores. In addition to RAS, I also develop secondary outcome models that perform well at predicting pressor weaning (AUC=0.825), intraaortic balloon pump removal (AUC=0.816), the onset of septic shock (AUC=0.843), and acute kidney injury (AUC=0.742). Real-time mortality prediction is a feasible way to provide continuous risk assessment for ICU patients. RAS offers similar discrimination ability when compared to models computed once per day, based on aggregate data over that day.(cont.) Moreover, RAS mortality predictions are better at discrimination than a customized SAPS II score (Day 3 AUC=0.878 vs AUC=0.849, p < 0.05). The secondary outcome models also provide interesting insights into patient responses to care and patient risk profiles. While models trained for specifically recognizing secondary outcomes consistently outperform the RAS model at their specific tasks, RAS provides useful baseline risk estimates throughout these events and in some cases offers a notable level of predictive utility.by Caleb Wayne Hug.Ph.D

Predicting the Risk and Trajectory of Intensive Care Patients Using Survival Models

SM thesisUsing artificial intelligence to assist physicians in patient care has received sustained interest over the past several decades. Recently, with automated systems at most bedsides, the amount of patient information collected continues to increase, providing specific impetus for intelligent systems that can interpret this information. In fact, the large set of sensors and test results, often measured repeatedly over long periods of time, make it challenging for caregivers to quickly utilize all of the data for optimal patient treatment.This research focuses on predicting the survival of ICU patients throughout their stay. Unlike traditional static mortality models, this survival prediction is explored as an indicator of patient state and trajectory. Using survival analysis techniques and machine learning, models are constructed that predict individual patient survival probabilities at fixed intervals in the future. These models seek to help physicians interpret the large amount of data available in order to provide optimal patient care.We find that the survival predictions from our models are comparable to survival predictions using the SAPS score, but are available throughout the patient's ICU course instead of only at 24 hours after admission. Additionally, we demonstrate effective prediction of patient mortality over fixed windows in the future

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace

Patients Using Survival Models

Using artificial intelligence to assist physicians in patient care has received sustained interest over the past several decades. Recently, with automated systems at most bedsides, the amount of patient information collected continues to increase, providing specific impetus for intelligent systems that can interpret this information. In fact, the large set of sensors and test results, often measured repeatedly over long periods of time, make it challenging for caregivers to quickly utilize all of the data for optimal patient treatment. This research focuses on predicting the survival of ICU patients throughout their stay. Unlike traditional static mortality models, this survival prediction is explored as an indicator of patient state and trajectory. Using survival analysis techniques and machine learning, models are constructed that predict individual patient survival probabilities at fixed intervals in the future. These models seek to help physicians interpret the large amount of data available in order to provide optimal patient care. We find that the survival predictions from our models are comparable to surviva