• Matthew M Churpek, Trevor C Yuen, Christopher Winslow, David O Meltzer, Michael W Kattan, and Dana P Edelson.
• 1Department of Medicine, University of Chicago, Chicago, IL. 2Department of Medicine, NorthShore University HealthSystem, Evanston, IL. 3Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
• Crit. Care Med. 2016 Feb 1; 44 (2): 368-74.

ObjectiveMachine learning methods are flexible prediction algorithms that may be more accurate than conventional regression. We compared the accuracy of different techniques for detecting clinical deterioration on the wards in a large, multicenter database.DesignObservational cohort study.SettingFive hospitals, from November 2008 until January 2013.PatientsHospitalized ward patientsInterventionsNoneMeasurements And Main ResultsDemographic variables, laboratory values, and vital signs were utilized in a discrete-time survival analysis framework to predict the combined outcome of cardiac arrest, intensive care unit transfer, or death. Two logistic regression models (one using linear predictor terms and a second utilizing restricted cubic splines) were compared to several different machine learning methods. The models were derived in the first 60% of the data by date and then validated in the next 40%. For model derivation, each event time window was matched to a non-event window. All models were compared to each other and to the Modified Early Warning score, a commonly cited early warning score, using the area under the receiver operating characteristic curve (AUC). A total of 269,999 patients were admitted, and 424 cardiac arrests, 13,188 intensive care unit transfers, and 2,840 deaths occurred in the study. In the validation dataset, the random forest model was the most accurate model (AUC, 0.80 [95% CI, 0.80-0.80]). The logistic regression model with spline predictors was more accurate than the model utilizing linear predictors (AUC, 0.77 vs 0.74; p < 0.01), and all models were more accurate than the MEWS (AUC, 0.70 [95% CI, 0.70-0.70]).ConclusionsIn this multicenter study, we found that several machine learning methods more accurately predicted clinical deterioration than logistic regression. Use of detection algorithms derived from these techniques may result in improved identification of critically ill patients on the wards.

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