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Advancing In-Hospital Clinical Deterioration Prediction Models.


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.

SUBMITTER: Jeffery AD 

PROVIDER: S-EPMC6141236 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Advancing In-Hospital Clinical Deterioration Prediction Models.

Jeffery Alvin D AD   Dietrich Mary S MS   Fabbri Daniel D   Kennedy Betsy B   Novak Laurie L LL   Coco Joseph J   Mion Lorraine C LC  

American journal of critical care : an official publication, American Association of Critical-Care Nurses 20180901 5


<h4>Background</h4>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.<h4>Objectives</h4>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.<h4>Methods</h4>Retrospective cohort s  ...[more]

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