Cited by 326Machine Learning in HealthcareEmergency and Acute Care StudiesArtificial Intelligence in Healthcare

The DOI matches its Crossref record; 57 of the 58 references it cites were found in a registry or an index; none of the 46 sources its claims cite is checked for support yet.

Predicting hospital admission at emergency department triage using machine learning

Open access

Abstract

OBJECTIVE: To predict hospital admission at the time of ED triage using patient history in addition to information collected at triage. METHODS: This retrospective study included all adult ED visits between March 2014 and July 2017 from one academic and two community emergency rooms that resulted in either admission or discharge. A total of 972 variables were extracted per patient visit. Samples were randomly partitioned into training (80%), validation (10%), and test (10%) sets. We trained a series of nine binary classifiers using logistic regression (LR), gradient boosting (XGBoost), and deep neural networks (DNN) on three dataset types: one using only triage information, one using only patient history, and one using the full set of variables. Next, we tested the potential benefit of additional training samples by training models on increasing fractions of our data. Lastly, variables of importance were identified using information gain as a metric to create a low-dimensional model. RESULTS: A total of 560,486 patient visits were included in the study, with an overall admission risk of 29.7%. Models trained on triage information yielded a test AUC of 0.87 for LR (95% CI 0.86-0.87), 0.87 for XGBoost (95% CI 0.87-0.88) and 0.87 for DNN (95% CI 0.87-0.88). Models trained on patient history yielded an AUC of 0.86 for LR (95% CI 0.86-0.87), 0.87 for XGBoost (95% CI 0.87-0.87) and 0.87 for DNN (95% CI 0.87-0.88). Models trained on the full set of variables yielded an AUC of 0.91 for LR (95% CI 0.91-0.91), 0.92 for XGBoost (95% CI 0.92-0.93) and 0.92 for DNN (95% CI 0.92-0.92). All algorithms reached maximum performance at 50% of the training set or less. A low-dimensional XGBoost model built on ESI level, outpatient medication counts, demographics, and hospital usage statistics yielded an AUC of 0.91 (95% CI 0.91-0.91). CONCLUSION: Machine learning can robustly predict hospital admission using triage information and patient history. The addition of historical information improves predictive performance significantly compared to using triage information alone, highlighting the need to incorporate these variables into prediction models.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Machine learning models using electronic health record data predicted hospital admission at ED triage, with full-variable models reaching test AUCs of 0.91–0.92. Adding patient history significantly improved performance over triage information alone.

Key findings

  • Among 560,486 adult ED visits with an overall admission risk of 29.7%, full-variable models achieved test AUC 0.91 for logistic regression, 0.92 for XGBoost, and 0.92 for deep neural networks; triage-only and history-only models achieved AUCs around 0.86–0.87.
  • A low-dimensional XGBoost model using ESI level, outpatient medication counts, demographics, and hospital usage statistics yielded an AUC of 0.91 (95% CI 0.91–0.91).
  • All algorithms reached maximum performance at 50% of the training set or less; logistic regression reached it at 10%, while XGBoost and DNN reached it at 50%.
  • XGBoost and DNN outperformed logistic regression on the full dataset, with no significant difference between XGBoost and DNN across the three dataset types.

Methods

  • Retrospective study of all adult ED visits between March 2014 and July 2017 from one academic and two community EDs that ended in admission or discharge; 972 variables were extracted per visit, and 560,486 visits were randomly partitioned into training (80%), validation (10%), and test (10%) sets.
  • Nine binary classifiers were trained using logistic regression, XGBoost, and deep neural networks on three dataset types: triage information only, patient history only, and the full variable set; hyperparameters were optimized by average validation AUC across five validation sets, and test AUCs were calculated with DeLong 95% CIs.
  • Additional analyses trained full-variable models on increasing fractions of the training set (1%, 10%, 30%, 50%, 80%, 100%) and used information gain from 100 XGBoost iterations to identify important variables and build a low-dimensional model.

Limitations

  • The paper states that patient history was restricted to previous ED visits, and expanding to outpatient or inpatient data may improve performance but could present EHR integration and differing-standards difficulties.
  • The paper states that data came from one hospital system with multiple EDs and a large catchment area, and extending the approach to dense urban areas with multiple independent EDs may be difficult because patients may not consistently present to the same system.
  • The paper states that the outcome label was the ED provider’s prior disposition decision, so appropriateness of individual clinical decisions could not be assessed, and it does not address implementation or efficacy barriers in clinical practice; evident from the text, the study is retrospective, adult-only, excludes non-admission/discharge dispositions, and uses a held-out test set from the same health system rather than external validation.

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Integrity signals

Registry

Crossref · 10.1371/journal.pone.0201016

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

Show all 37 claims

  • It may state two separate claims as one. 5
  • The quote only partly states this claim. 1
  • Probably not a substantial claim. 10
13 of 13
  • The paper relies on this without support.

    Gradient boosting and deep neural networks have not been applied to the task of predicting admission at ED triage to date.

    “While gradient boosting and deep neural networks have been shown to be powerful tools for predictive modeling, neither has been applied to the task of predicting admission at ED triage to date.”
  • The paper relies on this without support.

    The three EDs studied are representative of EDs generally, so the models' performance generalizes to other settings.

    “Machine learning can robustly predict hospital admission using triage information and patient history.”
  • The paper relies on this without support.

    The historical information available in the EHR at the time of triage is sufficiently complete and accurate to predict admission.

    “For each patient visit, we collected a total of 972 variables, divided into major categories shown in Table 1.”
  • The paper relies on this without support.

    The ED provider's prior decision is a valid ground truth for hospital admission.

    “Throughout this study, we predict patient disposition by using the ED provider's prior decision as our true label.”
  • The paper relies on this without support.

    The variables used in the models are available at the time of emergency department triage.

    “Our study shows that machine learning can robustly predict hospital admission at emergency department (ED) triage”
5 of 5

Claims other papers make about this one

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting descriptions of how model cutoffs were chosen

    Minor

    The methods say Youden's index determined the cutoff for each model. Table 3 instead says every model's cutoff was set to a fixed specificity of 0.85, chosen using Youden's index only on the full XGBoost model.

1 of 1

Citations

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Show all 58 references

1 of the 58 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. M Kuhn, 2013, Chapter 3. Data Pre-processing. Applied Predictive Modeling, Springer Science & Business Media, 27

Cited by

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Items 301–326 of 326

Metadata

Authors
Hong, W. S., Haimovich, A. D., & Taylor, R. A.
Affiliations
Yale University (US)
Corresponding author
Taylor, R. Andrew
Venue
PLOS ONE
Published
2018-07-20
Volume
13
Issue
7
Pages
e0201016
ISSN
1932-6203 (ISSN-L)
OpenAlex
W2884597820
Cited by
326
References
58
Citations by year
2026: 51 · 2025: 55 · 2024: 47 · 2023: 39 · 2022: 46 · 2021: 39 · 2020: 30 · 2019: 18 · 2018: 1
FWCI
12.22
Type
journal article
Language
en
Open access
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • National Institutes of Health (1F30CA196191, T32GM007205)
  • Yale School of Medicine
Topics
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
Keywords
emergency department triage, hospital admission prediction, medical history, Emergency Severity Index, hospital utilization, XGBoost, deep neural network, logistic regression, feature importance, information gain, low-dimensional models, training data size, model generalization, clinical decision support
MeSH terms
Machine Learning, Adult, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Patient Admission, Patient Discharge, Triage, Models, Statistical

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