Subscribe to the gold package and get unlimited access to Shamra Academy
Register a new userCOVID-Net Clinical ICU: Enhanced Prediction of ICU Admission for COVID-19 Patients via Explainability and Trust Quantification
97
0
0.0
(
0
)
Added by
Alexander Wong
Publication date
2021
fields
Informatics Engineering
and research's language is
English
Ask ChatGPT about the research
No Arabic abstract
The COVID-19 pandemic continues to have a devastating global impact, and has placed a tremendous burden on struggling healthcare systems around the world. Given the limited resources, accurate patient triaging and care planning is critical in the fight against COVID-19, and one crucial task within care planning is determining if a patient should be admitted to a hospitals intensive care unit (ICU). Motivated by the need for transparent and trustworthy ICU admission clinical decision support, we introduce COVID-Net Clinical ICU, a neural network for ICU admission prediction based on patient clinical data. Driven by a transparent, trust-centric methodology, the proposed COVID-Net Clinical ICU was built using a clinical dataset from Hospital Sirio-Libanes comprising of 1,925 COVID-19 patients, and is able to predict when a COVID-19 positive patient would require ICU admission with an accuracy of 96.9% to facilitate better care planning for hospitals amidst the on-going pandemic. We conducted system-level insight discovery using a quantitative explainability strategy to study the decision-making impact of different clinical features and gain actionable insights for enhancing predictive performance. We further leveraged a suite of trust quantification metrics to gain deeper insights into the trustworthiness of COVID-Net Clinical ICU. By digging deeper into when and why clinical predictive models makes certain decisions, we can uncover key factors in decision making for critical clinical decision support tasks such as ICU admission prediction and identify the situations under which clinical predictive models can be trusted for greater accountability.
rate research
Read More
We consider here an extended SIR model, including several features of the recent COVID-19 outbreak: in particular the infected and recovered individuals can either be detected (+) or undetected (-) and we also integrate an intensive care unit (ICU) capacity. Our model enables a tractable quantitative analysis of the optimal policy for the control of the epidemic dynamics using both lockdown and detection intervention levers. With parametric specification based on literature on COVID-19, we investigate the sensitivities of various quantities on the optimal strategies, taking into account the subtle trade-off between the sanitary and the socio-economic cost of the pandemic, together with the limited capacity level of ICU. We identify the optimal lockdown policy as an intervention structured in 4 successive phases: First a quick and strong lockdown intervention to stop the exponential growth of the contagion; second a short transition phase to reduce the prevalence of the virus; third a long period with full ICU capacity and stable virus prevalence; finally a return to normal social interactions with disappearance of the virus. The optimal scenario hereby avoids the second wave of infection, provided the lockdown is released sufficiently slowly. We also provide optimal intervention measures with increasing ICU capacity, as well as optimization over the effort on detection of infectious and immune individuals. Whenever massive resources are introduced to detect infected individuals, the pressure on social distancing can be released, whereas the impact of detection of immune individuals reveals to be more moderate.
As the second wave in India mitigates, COVID-19 has now infected about 29 million patients countrywide, leading to more than 350 thousand people dead. As the infections surged, the strain on the medical infrastructure in the country became apparent. While the country vaccinates its population, opening up the economy may lead to an increase in infection rates. In this scenario, it is essential to effectively utilize the limited hospital resources by an informed patient triaging system based on clinical parameters. Here, we present two interpretable machine learning models predicting the clinical outcomes, severity, and mortality, of the patients based on routine non-invasive surveillance of blood parameters from one of the largest cohorts of Indian patients at the day of admission. Patient severity and mortality prediction models achieved 86.3% and 88.06% accuracy, respectively, with an AUC-ROC of 0.91 and 0.92. We have integrated both the models in a user-friendly web app calculator, https://triage-COVID-19.herokuapp.com/, to showcase the potential deployment of such efforts at scale.
Machine Learning (ML) models typically require large-scale, balanced training data to be robust, generalizable, and effective in the context of healthcare. This has been a major issue for developing ML models for the coronavirus-disease 2019 (COVID-19) pandemic where data is highly imbalanced, particularly within electronic health records (EHR) research. Conventional approaches in ML use cross-entropy loss (CEL) that often suffers from poor margin classification. For the first time, we show that contrastive loss (CL) improves the performance of CEL especially for imbalanced EHR data and the related COVID-19 analyses. This study has been approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai. We use EHR data from five hospitals within the Mount Sinai Health System (MSHS) to predict mortality, intubation, and intensive care unit (ICU) transfer in hospitalized COVID-19 patients over 24 and 48 hour time windows. We train two sequential architectures (RNN and RETAIN) using two loss functions (CEL and CL). Models are tested on full sample data set which contain all available data and restricted data set to emulate higher class imbalance.CL models consistently outperform CEL models with the restricted data set on these tasks with differences ranging from 0.04 to 0.15 for AUPRC and 0.05 to 0.1 for AUROC. For the restricted sample, only the CL model maintains proper clustering and is able to identify important features, such as pulse oximetry. CL outperforms CEL in instances of severe class imbalance, on three EHR outcomes with respect to three performance metrics: predictive power, clustering, and feature importance. We believe that the developed CL framework can be expanded and used for EHR ML work in general.
As the COVID-19 pandemic continues to devastate globally, one promising field of research is machine learning-driven computer vision to streamline various parts of the COVID-19 clinical workflow. These machine learning methods are typically stand-alone models designed without consideration for the integration necessary for real-world application workflows. In this study, we take a machine learning and systems (MLSys) perspective to design a system for COVID-19 patient screening with the clinical workflow in mind. The COVID-Net system is comprised of the continuously evolving COVIDx dataset, COVID-Net deep neural network for COVID-19 patient detection, and COVID-Net S deep neural networks for disease severity scoring for COVID-19 positive patient cases. The deep neural networks within the COVID-Net system possess state-of-the-art performance, and are designed to be integrated within a user interface (UI) for clinical decision support with automatic report generation to assist clinicians in their treatment decisions.
We estimate the growth in demand for ICU beds in Chicago during the emerging COVID-19 epidemic, using state-of-the-art computer simulations calibrated for the SARS-CoV-2 virus. The questions we address are these: (1) Will the ICU capacity in Chicago be exceeded, and if so by how much? (2) Can strong mitigation strategies, such as lockdown or shelter in place order, prevent the overflow of capacity? (3) When should such strategies be implemented? Our answers are as follows: (1) The ICU capacity may be exceeded by a large amount, probably by a factor of ten. (2) Strong mitigation can avert this emergency situation potentially, but even that will not work if implemented too late. (3) If the strong mitigation precedes April 1st, then the growth of COVID-19 can be controlled and the ICU capacity could be adequate. The earlier the strong mitigation is implemented, the greater the probability that it will be successful. After around April 1 2020, any strong mitigation will not avert the emergency situation. In Italy, the lockdown occurred too late and the number of deaths is still doubling every 2.3 days. It is difficult to be sure about the precise dates for this window of opportunity, due to the inherent uncertainties in computer simulation. But there is high confidence in the main conclusion that it exists and will soon be closed. Our conclusion is that, being fully cognizant of the societal trade-offs, there is a rapidly closing window of opportunity to avert a worst-case scenario in Chicago, but only with strong mitigation/lockdown implemented in the next week at the latest. If this window is missed, the epidemic will get worse and then strong mitigation/lockdown will be required after all, but it will be too late.
suggested questions
Log in to be able to interact and post comments
comments
Fetching comments
Sign in to be able to follow your search criteria
