TY - JOUR
T1 - Dynamic Mortality Risk Predictions for Children in ICUs
T2 - Development and Validation of Machine Learning Models∗
AU - Trujillo Rivera, Eduardo A.
AU - Chamberlain, James M.
AU - Patel, Anita K.
AU - Morizono, Hiroki
AU - Heneghan, Julia A.
AU - Pollack, Murray M.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - OBJECTIVES: Assess a machine learning method of serially updated mortality risk. DESIGN: Retrospective analysis of a national database (Health Facts; Cerner Corporation, Kansas City, MO). SETTING: Hospitals caring for children in ICUs. PATIENTS: A total of 27,354 admissions cared for in ICUs from 2009 to 2018. INTERVENTIONS: None. MAIN OUTCOME: Hospital mortality risk estimates determined at 6-hour time periods during care in the ICU. Models were truncated at 180 hours due to decreased sample size secondary to discharges and deaths. MEASUREMENTS AND MAIN RESULTS: The Criticality Index, based on physiology, therapy, and care intensity, was computed for each admission for each time period and calibrated to hospital mortality risk (Criticality Index-Mortality [CI-M]) at each of 29 time periods (initial assessment: 6 hr; last assessment: 180 hr). Performance metrics and clinical validity were determined from the held-out test sample (n = 3,453, 13%). Discrimination assessed with the area under the receiver operating characteristic curve was 0.852 (95% CI, 0.843-0.861) overall and greater than or equal to 0.80 for all individual time periods. Calibration assessed by the Hosmer-Lemeshow goodness-of-fit test showed good fit overall (p = 0.196) and was statistically not significant for 28 of the 29 time periods. Calibration plots for all models revealed the intercept ranged from - 0.002 to 0.009, the slope ranged from 0.867 to 1.415, and the R2ranged from 0.862 to 0.989. Clinical validity assessed using population trajectories and changes in the risk status of admissions (clinical volatility) revealed clinical trajectories consistent with clinical expectations and greater clinical volatility in deaths than survivors (p < 0.001). CONCLUSIONS: Machine learning models incorporating physiology, therapy, and care intensity can track changes in hospital mortality risk during intensive care. The CI-M's framework and modeling method are potentially applicable to monitoring clinical improvement and deterioration in real time.
AB - OBJECTIVES: Assess a machine learning method of serially updated mortality risk. DESIGN: Retrospective analysis of a national database (Health Facts; Cerner Corporation, Kansas City, MO). SETTING: Hospitals caring for children in ICUs. PATIENTS: A total of 27,354 admissions cared for in ICUs from 2009 to 2018. INTERVENTIONS: None. MAIN OUTCOME: Hospital mortality risk estimates determined at 6-hour time periods during care in the ICU. Models were truncated at 180 hours due to decreased sample size secondary to discharges and deaths. MEASUREMENTS AND MAIN RESULTS: The Criticality Index, based on physiology, therapy, and care intensity, was computed for each admission for each time period and calibrated to hospital mortality risk (Criticality Index-Mortality [CI-M]) at each of 29 time periods (initial assessment: 6 hr; last assessment: 180 hr). Performance metrics and clinical validity were determined from the held-out test sample (n = 3,453, 13%). Discrimination assessed with the area under the receiver operating characteristic curve was 0.852 (95% CI, 0.843-0.861) overall and greater than or equal to 0.80 for all individual time periods. Calibration assessed by the Hosmer-Lemeshow goodness-of-fit test showed good fit overall (p = 0.196) and was statistically not significant for 28 of the 29 time periods. Calibration plots for all models revealed the intercept ranged from - 0.002 to 0.009, the slope ranged from 0.867 to 1.415, and the R2ranged from 0.862 to 0.989. Clinical validity assessed using population trajectories and changes in the risk status of admissions (clinical volatility) revealed clinical trajectories consistent with clinical expectations and greater clinical volatility in deaths than survivors (p < 0.001). CONCLUSIONS: Machine learning models incorporating physiology, therapy, and care intensity can track changes in hospital mortality risk during intensive care. The CI-M's framework and modeling method are potentially applicable to monitoring clinical improvement and deterioration in real time.
KW - criticality index
KW - dynamic modeling
KW - mortality risk
KW - pediatric intensive care unit
KW - pediatrics
KW - severity of illness
UR - http://www.scopus.com/inward/record.url?scp=85130768152&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130768152&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000002910
DO - 10.1097/PCC.0000000000002910
M3 - Article
C2 - 35190501
AN - SCOPUS:85130768152
SN - 1529-7535
VL - 23
SP - 344
EP - 352
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 5
ER -