Predicting presumed serious infection among hospitalized children on central venous lines with machine learning

Azade Tabaie*, Evan W. Orenstein, Shamim Nemati, Rajit K. Basu, Swaminathan Kandaswamy, Gari D. Clifford, Rishikesan Kamaleswaran

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: Presumed serious infection (PSI) is defined as a blood culture drawn and new antibiotic course of at least 4 days among pediatric patients with Central Venous Lines (CVLs). Early PSI prediction and use of medical interventions can prevent adverse outcomes and improve the quality of care. Methods: Clinical features including demographics, laboratory results, vital signs, characteristics of the CVLs and medications used were extracted retrospectively from electronic medical records. Data were aggregated across all hospitals within a single pediatric health system and used to train machine learning models (XGBoost and ElasticNet) to predict the occurrence of PSI 8 h prior to clinical suspicion. Prediction for PSI was benchmarked against PRISM-III. Results: Our model achieved an area under the receiver operating characteristic curve of 0.84 (95% CI = [0.82, 0.85]), sensitivity of 0.73 [0.69, 0.74], and positive predictive value (PPV) of 0.36 [0.34, 0.36]. The PRISM-III conversely achieved a lower sensitivity of 0.19 [0.16, 0.22] and PPV of 0.30 [0.26, 0.34] at a cut-off of ≥ 10. The features with the most impact on the PSI prediction were maximum diastolic blood pressure prior to PSI prediction (mean SHAP = 3.4), height (mean SHAP = 3.2), and maximum temperature prior to PSI prediction (mean SHAP = 2.6). Conclusion: A machine learning model using common features in the electronic medical records can predict the onset of serious infections in children with central venous lines at least 8 h prior to when a clinical team drew a blood culture.

Original languageEnglish (US)
Article number104289
JournalComputers in Biology and Medicine
Volume132
DOIs
StatePublished - May 2021

Funding

Financial support used for the study, including any institutional departmental funds: This project was supported by an institutional grant provided by the Children’s Healthcare of Atlanta, Atlanta , GA through The Pediatric Technology Center, in conjunction with the Health Analytics Council. AT was also funded by the Surgical Critical Care Initiative (SC2i) , Department of Defense’s Defense Health Program Joint Program Committee 6 / Combat Casualty Care ( USUHS HT9404-13-1-0032 and HU0001-15-2-0001 ). GC and SN were partially funded by the National Science Foundation , grant # 1822378 ‘Leveraging Heterogeneous Data Across International Borders in a Privacy Preserving Manner for Clinical Deep Learning'. GC is also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • CLABSI
  • Infection
  • Machine learning
  • Predictive model
  • Sepsis

ASJC Scopus subject areas

  • Health Informatics
  • Computer Science Applications

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