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Analysis and Prediction of Unplanned Intensive Care Unit Readmission using Recurrent Neural Networks with Long Short-Term Memory

By Yu-Wei Lin, Yuqian Zhou, Faraz Faghri, Michael J Shaw, Roy H Campbell

Posted 06 Aug 2018
bioRxiv DOI: 10.1101/385518 (published DOI: 10.1371/journal.pone.0218942)

Unplanned readmission of a hospitalized patient is an extremely undesirable outcome as the patient may have been exposed to additional risks. The rates of unplanned readmission are, therefore, regarded as an important performance indicator for the medical quality of a hospital and healthcare system. Identifying high-risk patients likely to suffer from readmission before release benefits both the patients and the medical providers. The emergence of machine learning to detect hidden patterns in complex, multi-dimensional datasets provides unparalleled opportunities to develop an efficient discharge decision-making support system for physicians. We used supervised machine learning approaches for ICU readmission prediction. We used machine learning methods on comprehensive, longitudinal clinical data from the MIMIC-III to predict the ICU readmission of patients within 30 days of their discharge. We have utilized recent machine learning techniques such as Recurrent Neural Networks (RNN) with Long Short-Term Memory (LSTM), by this we have been able incorporate the multivariate features of EHRs and capture sudden fluctuations in chart event features (e.g. glucose and heart rate) that are significant in time series with temporal dependencies, which cannot be properly captured by traditional static models, but can be captured by our proposed deep neural network based model. We incorporate multiple types of features including chart events, demographic, and ICD9 embeddings. Our machine learning model identifies ICU readmissions at a higher sensitivity rate (0.742) and an improved Area Under the Curve (0.791) compared with traditional methods. We also illustrate the importance of each portion of the features and different combinations of the models to verify the effectiveness of the proposed model. Our manuscript highlights the ability of machine learning models to improve our ICU decision-making accuracy and is a real-world example of precision medicine in hospitals. These data-driven results enable clinicians to make assisted decisions within their patient cohorts. This knowledge could have immediate implications for hospitals by improving the detection of possible readmission. We anticipate that machine learning models will improve patient counseling, hospital administration, allocation of healthcare resources and ultimately individualized clinical care.

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