• Thomas Tschoellitsch, Philipp Seidl, Carl Böck, Alexander Maletzky, Philipp Moser, Stefan Thumfart, Michael Giretzlehner, Sepp Hochreiter, and Jens Meier.
• Johannes Kepler University Linz, Kepler University Hospital, Department of Anesthesiology and Critical Care Medicine.
• Eur J Emerg Med. 2023 Dec 1; 30 (6): 408416408-416.

AimsPatient admission is a decision relying on sparsely available data. This study aims to provide prediction models for discharge versus admission for ward observation or intensive care, and 30 day-mortality for patients triaged with the Manchester Triage System.MethodsThis is a single-centre, observational, retrospective cohort study from data within ten minutes of patient presentation at the interdisciplinary emergency department of the Kepler University Hospital, Linz, Austria. We trained machine learning models including Random Forests and Neural Networks individually to predict discharge versus ward observation or intensive care admission, and 30 day-mortality. For analysis of the features' relevance, we used permutation feature importance.ResultsA total of 58323 adult patients between 1 December 2015 and 31 August 2020 were included. Neural Networks and Random Forests predicted admission to ward observation with an AUC-ROC of 0.842 ± 0.00 with the most important features being age and chief complaint. For admission to intensive care, the models had an AUC-ROC of 0.819 ± 0.002 with the most important features being the Manchester Triage category and heart rate, and for the outcome 30 day-mortality an AUC-ROC of 0.925 ± 0.001. The most important features for the prediction of 30 day-mortality were age and general ward admission.ConclusionMachine learning can provide prediction on discharge versus admission to general wards and intensive care and inform about risk on 30 day-mortality for patients in the emergency department.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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