TY - JOUR

T1 - Improving Mortality Models in the ICU with High-Frequency Data

AU - Todd, James

AU - Gepp, Adrian

AU - Richards, Brent

AU - Vanstone, Bruce J

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: Assessment of the performance of Intensive Care Units (ICU) is of vital importance for an effectivehealthcare system. Such assessment ensures that the limited resources of the healthcare system are allocatedwhere they are most needed. Severity scoring systems are employed for this purpose and improving these systemsis a continuing area of research which has focused on the use of more complex techniques and newvariables.Objectives: This paper investigates whether scoring systems could be improved through use of metrics whichbetter summarise the high frequency data collected by automated systems for patients in the ICU.Methods and Data: 3128 admissions to the Gold Coast University Hospital ICU are used to construct three logisticregressions based on the most widely used scoring system (APACHE III) to compare performance with andwithout predictors leveraging available high frequency information. Performance is assessed based on modelaccuracy, calibration, and discrimination. High frequency information was considered for existing pulse andmean arterial pressure physiology fields and resulting models compared against a baseline logistic regressionusing only APACHE III physiology variables.Results: Model discrimination and accuracy were better for models which included high frequency predictors,with calibration remaining good in all cases. The most influential high frequency summaries were the number ofturning points in a patient’s mean arterial pressure or pulse in the first 24 h of ICU admission.Conclusions: The findings indicate that scoring systems can be improved by better accounting for high frequencydata.

AB - Background: Assessment of the performance of Intensive Care Units (ICU) is of vital importance for an effectivehealthcare system. Such assessment ensures that the limited resources of the healthcare system are allocatedwhere they are most needed. Severity scoring systems are employed for this purpose and improving these systemsis a continuing area of research which has focused on the use of more complex techniques and newvariables.Objectives: This paper investigates whether scoring systems could be improved through use of metrics whichbetter summarise the high frequency data collected by automated systems for patients in the ICU.Methods and Data: 3128 admissions to the Gold Coast University Hospital ICU are used to construct three logisticregressions based on the most widely used scoring system (APACHE III) to compare performance with andwithout predictors leveraging available high frequency information. Performance is assessed based on modelaccuracy, calibration, and discrimination. High frequency information was considered for existing pulse andmean arterial pressure physiology fields and resulting models compared against a baseline logistic regressionusing only APACHE III physiology variables.Results: Model discrimination and accuracy were better for models which included high frequency predictors,with calibration remaining good in all cases. The most influential high frequency summaries were the number ofturning points in a patient’s mean arterial pressure or pulse in the first 24 h of ICU admission.Conclusions: The findings indicate that scoring systems can be improved by better accounting for high frequencydata.

U2 - 10.1016/j.ijmedinf.2019.07.002

DO - 10.1016/j.ijmedinf.2019.07.002

M3 - Article

VL - 129

SP - 318

EP - 323

JO - International Journal of Medical Informatics

JF - International Journal of Medical Informatics

SN - 1386-5056

ER -