Prediction of cardiac arrest in critically ill patients presenting to the emergency department using a machine learning score incorporating heart rate variability compared with the modified early warning score 英文参考文献.docVIP

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Prediction of cardiac arrest in critically ill patients presenting to the emergency department using a machine learning score incorporating heart rate variability compared with the modified early warning score 英文参考文献.doc

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Prediction of cardiac arrest in critically ill patients presenting to the emergency department using a machine learning score incorporating heart rate variability compared with the modified early warning score 英文参考文献

HockOngetal.CriticalCare2012,16:R108 /content/16/3/R108 RESEARCH OpenAccess Predictionofcardiacarrestincriticallyillpatients presentingtotheemergencydepartmentusinga machinelearningscoreincorporatingheartrate variabilitycomparedwiththemodifiedearly warningscore MarcusEngHockOng1*,ChristinaHuiLeeNg2,KenGoh3,NanLiu1,ZhiXiongKoh1,NurShahidah1, TongTongZhang1,StephanieFook-Chong4andZhipingLin5 Abstract Introduction:Akeyaimoftriageistoidentifythosewithhighriskofcardiacarrest,astheyrequireintensive monitoring,resuscitationfacilities,andearlyintervention.Weaimtovalidateanovelmachinelearning(ML)score incorporatingheartratevariability(HRV)fortriageofcriticallyillpatientspresentingtotheemergencydepartment bycomparingtheareaunderthecurve,sensitivityandspecificitywiththemodifiedearlywarningscore(MEWS). Methods:Weconductedaprospectiveobservationalstudyofcriticallyillpatients(PatientAcuityCategoryScale1 and2)inanemergencydepartmentofatertiaryhospital.Atpresentation,HRVparametersgeneratedfroma5- minuteelectrocardiogramrecordingareincorporatedwithageandvitalsignstogeneratetheMLscoreforeach patient.Thepatientsarethenfollowedupforoutcomesofcardiacarrestordeath. Results:FromJune2006toJune2008weenrolled925patients.Theareaunderthereceiveroperating characteristiccurve(AUROC)forMLscoresinpredictingcardiacarrestwithin72hoursis0.781,comparedwith 0.680forMEWS(differenceinAUROC:0.101,95%confidenceinterval:0.006to0.197).Asforin-hospitaldeath,the areaunderthecurveforMLscoreis0.741,comparedwith0.693forMEWS(differenceinAUROC:0.048,95% confidenceinterval:-0.023to0.119).AcutoffMLscore≥60predictedcardiacarrestwithasensitivityof84.1%, specificityof72.3%andnegativepredictivevalueof98.8%.AcutoffMEWS≥3predictedcardiacarrestwitha sensitivityof74.4%,specificityof54.2%andnegativepredictivevalueof97.8%. Conclusion:WefoundMLscorestobemoreaccuratethantheMEWSinpredictingcardiacarrestwithin72hours. Thereispotentialtodevelopbedsidedevicesforriskstratificationbasedoncardiacarrestprediction. Introduction playsan