Validation of a Machine Learning Model for Early Shock Detection.

OBJECTIVES: The objectives of this study were to test in real time a Trauma Triage, Treatment, and Training Decision Support (4TDS) machine learning (ML) model of shock detection in a prospective silent trial, and to evaluate specificity, sensitivity, and other estimates of diagnostic performance compared to the gold standard of electronic medical records (EMRs) review. DESIGN: We performed a single-center diagnostic performance study. PATIENTS AND SETTING: A prospective cohort consisted of consecutive patients aged 18 years and older who were admitted from May 1 through September 30, 2020 to six Mayo Clinic intensive care units (ICUs) and five progressive care units. MEASUREMENTS AND MAIN RESULTS: During the study time, 5,384 out of 6,630 hospital admissions were eligible. During the same period, the 4TDS shock model sent 825 alerts and 632 were eligible. Among 632 hospital admissions with alerts, 287 were screened positive and 345 were negative. Among 4,752 hospital admissions without alerts, 78 were screened positive and 4,674 were negative. The area under the receiver operating characteristics curve for the 4TDS shock model was 0.86 (95% CI 0.85-0.87%). The 4TDS shock model demonstrated a sensitivity of 78.6% (95% CI 74.1-82.7%) and a specificity of 93.1% (95% CI 92.4-93.8%). The model showed a positive predictive value of 45.4% (95% CI 42.6-48.3%) and a negative predictive value of 98.4% (95% CI 98-98.6%). CONCLUSIONS: We successfully validated an ML model to detect circulatory shock in a prospective observational study. The model used only vital signs and showed moderate performance compared to the gold standard of clinician EMR review when applied to an ICU patient cohort.

Decision Support for Tactical Combat Casualty Care Using Machine Learning to Detect Shock.

INTRODUCTION: The emergence of more complex Prolonged Field Care in austere settings and the need to assist inexperienced providers' ability to treat patients create an urgent need for effective tools to support care. We report on a project to develop a phone-/tablet-based decision support system for prehospital tactical combat casualty care that collects physiologic and other clinical data and uses machine learning to detect and differentiate shock manifestation. MATERIALS AND METHODS: Software interface development methods included literature review, rapid prototyping, and subject matter expert design requirements reviews. Machine learning algorithm methods included development of a model trained on publicly available Medical Information Mart for Intensive Care data, then on de-identified data from Mayo Clinic Intensive Care Unit. RESULTS: The project team interviewed 17 Army, Air Force, and Navy medical subject matter experts during design requirements review sessions. They had an average of 17 years of service in military medicine and an average of 4 deployments apiece and all had performed tactical combat casualty care on live patients during deployment. Comments provided requirements for shock identification and management in prehospital settings, including support for indication of shock probability and shock differentiation. The machine learning algorithm based on logistic regression performed best among other algorithms we tested and was able to predict shock onset 90 minutes before it occurred with better than 75% accuracy in the test dataset. CONCLUSIONS: We expect the Trauma Triage, Treatment, and Training Decision Support system will augment a medic's ability to make informed decisions based on salient patient data and to diagnose multiple types of shock through remotely trained, field deployed ML models.

NC HealthConnex and Value-based Care: Statewide Health Information Exchange as a Technology Tool for All.

A statewide health information exchange (HIE) can be a vital technology tool and play a pivotal role in driving health care innovation and better health outcomes, especially for providers participating in value-based care models. NC HealthConnex is the state-designated HIE network that gives participating providers secure and timely access to important patient data from more than 4,700 health care facilities spanning geographic locations and care settings.

The block spectrum of RNA pseudoknot structures.

In this paper we analyze the length-spectrum of blocks in [Formula: see text]-structures. [Formula: see text]-structures are a class of RNA pseudoknot structures that play a key role in the context of polynomial time RNA folding. A [Formula: see text]-structure is constructed by nesting and concatenating specific building components having topological genus at most [Formula: see text]. A block is a substructure enclosed by crossing maximal arcs with respect to the partial order induced by nesting. We show that, in uniformly generated [Formula: see text]-structures, there is a significant gap in this length-spectrum, i.e., there asymptotically almost surely exists a unique longest block of length at least [Formula: see text] and that with high probability any other block has finite length. For fixed [Formula: see text], we prove that the length of the complement of the longest block converges to a discrete limit law, and that the distribution of short blocks of given length tends to a negative binomial distribution in the limit of long sequences. We refine this analysis to the length spectrum of blocks of specific pseudoknot types, such as H-type and kissing hairpins. Our results generalize the rainbow spectrum on secondary structures by the first and third authors and are being put into context with the structural prediction of long non-coding RNAs.

Connecting Oral and Physical Health via the Health Information Exchange.

In 2015 North Carolina passed the Health Information Exchange Act, which mandates that all providers who receive state funds for the provision of health care services must connect and submit patient clinical and demographic data to the state-designated health information exchange by certain dates in 2018 and 2019. This article explains the statute and the benefits of health information exchange to support better oral health care.