Advancing In-Hospital Clinical Deterioration Prediction Models

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Abstract

Background

Early warning systems lack robust evidence that they improve patients’ outcomes, possibly because of their limitation of predicting binary rather than time-to-event outcomes.

Objectives

To compare the prediction accuracy of 2 statistical modeling strategies (logistic regression and Cox proportional hazards regression) and 2 machine learning strategies (random forest and random survival forest) for in-hospital cardiopulmonary arrest.

Methods

Retrospective cohort study with prediction model development from deidentified electronic health records at an urban academic medical center.

Results

The classification models (logistic regression and random forest) had statistical recall and precision similar to or greater than those of the time-to-event models (Cox proportional hazards regression and random survival forest). However, the time-to-event models provided predictions that could potentially better indicate to clinicians whether and when a patient is likely to experience cardiopulmonary arrest.

Conclusions

As early warning scoring systems are refined, they must use the best analytical methods that both model the underlying phenomenon and provide an understandable prediction.

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