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A Database-driven Decision Support System: Customized Mortality Prediction
Laboratory of Computational Physiology, Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, E25-505, Cambridge, MA 02139, USA
Department of Cardiac Surgery, Dunedin Hospital, 201 Great King Street, Dunedin 9054, New Zealand
Department of Radiology, Stanford Hospital, 300 Pasteur Drive, Stanford, CA 94305, USA
* Author to whom correspondence should be addressed.
Received: 2 August 2012; in revised form: 9 September 2012 / Accepted: 13 September 2012 / Published: 27 September 2012
Abstract: We hypothesize that local customized modeling will provide more accurate mortality prediction than the current standard approach using existing scoring systems. Mortality prediction models were developed for two subsets of patients in Multi-parameter Intelligent Monitoring for Intensive Care (MIMIC), a public de-identified ICU database, and for the subset of patients >80 years old in a cardiac surgical patient registry. Logistic regression (LR), Bayesian network (BN) and artificial neural network (ANN) were employed. The best-fitted models were tested on the remaining unseen data and compared to either the Simplified Acute Physiology Score (SAPS) for the ICU patients, or the EuroSCORE for the cardiac surgery patients. Local customized mortality prediction models performed better as compared to the corresponding current standard severity scoring system for all three subsets of patients: patients with acute kidney injury (AUC = 0.875 for ANN, vs. SAPS, AUC = 0.642), patients with subarachnoid hemorrhage (AUC = 0.958 for BN, vs. SAPS, AUC = 0.84), and elderly patients undergoing open heart surgery (AUC = 0.94 for ANN, vs. EuroSCORE, AUC = 0.648). Rather than developing models with good external validity by including a heterogeneous patient population, an alternative approach would be to build models for specific patient subsets using one’s local database.
Keywords: decision support; intensive care; clinical database; MIMIC; informatics
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Celi, L.A.; Galvin, S.; Davidzon, G.; Lee, J.; Scott, D.; Mark, R. A Database-driven Decision Support System: Customized Mortality Prediction. J. Pers. Med. 2012, 2, 138-148.
Celi LA, Galvin S, Davidzon G, Lee J, Scott D, Mark R. A Database-driven Decision Support System: Customized Mortality Prediction. Journal of Personalized Medicine. 2012; 2(4):138-148.
Celi, Leo Anthony; Galvin, Sean; Davidzon, Guido; Lee, Joon; Scott, Daniel; Mark, Roger. 2012. "A Database-driven Decision Support System: Customized Mortality Prediction." J. Pers. Med. 2, no. 4: 138-148.