Publications:Training machine learning models to predict 30-day mortality in patients discharged from the Emergency Department

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Title Training machine learning models to predict 30-day mortality in patients discharged from the Emergency Department
Author Mathias Blom and Awais Ashfaq and Anita Sant'Anna and Markus Lingman
Year 2019
PublicationType Journal Paper
Journal BMJ Open
HostPublication
Conference
DOI
Diva url http://hh.diva-portal.org/smash/record.jsf?searchId=1&pid=diva2:1313022
Abstract  Background: Aggressive treatment at end-of-life (EOL) can be traumatic to patients and may not add clinical benefit. Absent an accurate prognosis of death, individual level biases may prevent timely discussions about the scope of EOL care and patients are at risk of being subject to care against their desire. The aim of this work is to develop predictive algorithms for identifying patients at EOL, with clinically meaningful discriminatory power.Methods: Retrospective, population-based study of patients utilizing emergency departments (EDs) in Sweden, Europe. Electronic health records (EHRs) were used to train supervised learning algorithms to predict all-cause mortality within 30 days following ED discharge. Algorithm performance was validated out of sample on EHRs from a separate hospital, to which the algorithms were previously unexposed.Results: Of 65,776 visits in the development set, 136 (0.21%) experienced the outcome. The algorithm with highest discrimination attained ROC-AUC 0.945 (95% CI 0.933 - 0.956), withsensitivity 0.869 (95% CI 0.802, 0.931) and specificity 0.858 (0.855, 0.860) on the validation set.Conclusions: Multiple algorithms displayed excellent discrimination and outperformed available indexes for short-term mortality prediction. The practical utility of the algorithms increases as the required data were captured electronically and did not require de novo data collection.Trial registration number: Not applicable.