Cited by 96Machine Learning in HealthcareSepsis Diagnosis and TreatmentElectronic Health Records Systems

From data to optimal decision making: a data-driven, probabilistic machine learning approach to decision support for patients with sepsis

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Tsoukalas, Athanasios, Albertson, Timothy, Tagkopoulos, Ilias·2015·JMIR Medical Informatics

Abstract

BACKGROUND: A tantalizing question in medical informatics is how to construct knowledge from heterogeneous datasets, and as an extension, inform clinical decisions. The emergence of large-scale data integration in electronic health records (EHR) presents tremendous opportunities. However, our ability to efficiently extract informed decision support is limited due to the complexity of the clinical states and decision process, missing data and lack of analytical tools to advice based on statistical relationships. OBJECTIVE: Development and assessment of a data-driven method that infers the probability distribution of the current state of patients with sepsis, likely trajectories, optimal actions related to antibiotic administration, prediction of mortality and length-of-stay. METHODS: We present a data-driven, probabilistic framework for clinical decision support in sepsis-related cases. We first define states, actions, observations and rewards based on clinical practice, expert knowledge and data representations in an EHR dataset of 1492 patients. We then use Partially Observable Markov Decision Process (POMDP) model to derive the optimal policy based on individual patient trajectories and we evaluate the performance of the model-derived policies in a separate test set. Policy decisions were focused on the type of antibiotic combinations to administer. Multi-class and discriminative classifiers were used to predict mortality and length of stay. RESULTS: Data-derived antibiotic administration policies led to a favorable patient outcome in 49% of the cases, versus 37% when the alternative policies were followed (P=1.3e-13). Sensitivity analysis on the model parameters and missing data argue for a highly robust decision support tool that withstands parameter variation and data uncertainty. When the optimal policy was followed, 387 patients (25.9%) have 90% of their transitions to better states and 503 patients (33.7%) patients had 90% of their transitions to worse states (P=4.0e-06), while in the non-policy cases, these numbers are 192 (12.9%) and 764 (51.2%) patients (P=4.6e-117), respectively. Furthermore, the percentage of transitions within a trajectory that lead to a better or better/same state are significantly higher by following the policy than for non-policy cases (605 vs 344 patients, P=8.6e-25). Mortality was predicted with an AUC of 0.7 and 0.82 accuracy in the general case and similar performance was obtained for the inference of the length-of-stay (AUC of 0.69 to 0.73 with accuracies from 0.69 to 0.82). CONCLUSIONS: A data-driven model was able to suggest favorable actions, predict mortality and length of stay with high accuracy. This work provides a solid basis for a scalable probabilistic clinical decision support framework for sepsis treatment that can be expanded to other clinically relevant states and actions, as well as a data-driven model that can be adopted in other clinical areas with sufficient training data.

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  • ML tools for optimizing care outcomes have been used in critical care for optimizing sepsis management, management of chronic conditions, and optimizing surgical outcomes.

    “ML tools for optimizing care outcomes have been used in various settings, including critical care for optimizing sepsis management (27), management of chronic conditions (28), and optimizing surgical outcomes (29).”

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  1. [7]Ouali A Ramdane-Cherif Z Ramdane-Cherif A Levy N Krebs M Agent paradigm in clinical large-scale data mining environment 2003 2nd IEEE International Conference on Cognitive Informatics (ICCI) August 18-20, 2003 London, UK 143 150
  2. [8]Catley C Frize M A prototype XML-based implementation of an integrated intelligent neonatal intensive care unit 2003 8 18 4th International IEEE Conference on Information Technology Applications in Biomedicine 2003 London, UK 322 325
  3. [11]Foster D McGregor C El-Masri S A survey of agent-based intelligent decision support systems to support clinical management and research 2005 7 25 Fourth International Joint Conference on Autonomous Agents and Multiagent Systems 2005 Ultrecht, Netherlands 16 34
  4. [16]Howard RA Dynamic programming and markov processes Technology Press 1960 Boston, MA Massachusetts Institute of Technology
  5. [23]Faissol DM Griffin PM Timing of testing and treatment of hepatitis C and other diseases Proceedings 2007 INFORMS international meeting July 2007 Puerto Rico 11

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Authors
Tsoukalas, A., Albertson, T., & Tagkopoulos, I.
Affiliations
  • VA Northern California Health Care System (US)
  • University of California, Davis (US)
Corresponding author
Tagkopoulos, Ilias
Venue
JMIR Medical Informatics
Published
2015-02-24
Volume
3
Issue
1
Pages
e11
ISSN
2291-9694 (ISSN-L)
OpenAlex
W2000658385
Cited by
96
References
34
Citations by year
2026: 6 · 2025: 7 · 2024: 11 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 7 · 2019: 11 · 2018: 8 · 2017: 8 · 2016: 4 · 2015: 3 · 2014: 2
FWCI
7.50
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Medical Informatics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Center for Information Technology Research in the Interest of Society
  • National Institutes of Health (UL1TR000002, TR000002)
  • Center for Information Technology
  • National Center for Advancing Translational Sciences (#TR 000002)
Topics
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
sepsis, clinical decision support, partially observable Markov decision processes, electronic health records, mortality prediction, length of stay prediction, missing data, sensitivity analysis, probabilistic decision making, antibiotic combinations, sepsis management guidelines

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