Predicting presumed serious infection among hospitalized children on central venous lines with machine learning.

ABSTRACT

BACKGROUND: Presumed serious infection (PSI) is defined as a blood culture drawn and new antibiotic course of at least 4 days among pediatric patients with Central Venous Lines (CVLs). Early PSI prediction and use of medical interventions can prevent adverse outcomes and improve the quality of care. METHODS: Clinical features including demographics, laboratory results, vital signs, characteristics of the CVLs and medications used were extracted retrospectively from electronic medical records. Data were aggregated across all hospitals within a single pediatric health system and used to train machine learning models (XGBoost and ElasticNet) to predict the occurrence of PSI 8 h prior to clinical suspicion. Prediction for PSI was benchmarked against PRISM-III. RESULTS: Our model achieved an area under the receiver operating characteristic curve of 0.84 (95% CI = [0.82, 0.85]), sensitivity of 0.73 [0.69, 0.74], and positive predictive value (PPV) of 0.36 [0.34, 0.36]. The PRISM-III conversely achieved a lower sensitivity of 0.19 [0.16, 0.22] and PPV of 0.30 [0.26, 0.34] at a cut-off of ≥ 10. The features with the most impact on the PSI prediction were maximum diastolic blood pressure prior to PSI prediction (mean SHAP = 3.4), height (mean SHAP = 3.2), and maximum temperature prior to PSI prediction (mean SHAP = 2.6). CONCLUSION: A machine learning model using common features in the electronic medical records can predict the onset of serious infections in children with central venous lines at least 8 h prior to when a clinical team drew a blood culture.