OpenTalks.AI - Сергей Арсеньев, Опыт разработки Интегральных показателей тяжести состояния детей с тяжелой травмой на основе технологий машинного обучения

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1. Clinical and Research Institute for Emergency Pediatric Surgery and Trauma Sergei B. Arseniev arseniev@doctor-roshal.ru
2. Integral Homeostasis Index in a Decision Support System for the Assessment and Prediction of the Clinical Condition of Children with Severe Mechanical Trauma: Machine Learning Approach, Clinical Study Clinical and Research Institute for Emergency Pediatric Surgery and Trauma, Moscow Medical University of Vienna
3. Klaus-Peter Adlassnig Sergei B. Arseniev Valery Lukianov Valery Amcheslavsky CRIEPST Moscow Medical University of Vienna Contributors Medexter HealthCare GMGH, Vienna Andrea Rapрelsberger
4. Introduction • The daily assessment of acid-base balance (ABB) in blood is one of the important components of multi- parameter patient monitoring in intensive care • This analysis is basically used for routine clinical activities, mainly for the management of mechanical ventilation modes • However, ABB data potentially contains more important clinical information regarding the patient’s overall homeostasis
5. Background Integral Homeostasis Index (IHx) • In the earlier study Integral Homeostasis Index was proposed based on machine learning algorithms for classification of positive and negative clinical outcomes. • Several learning techniques were tested: 1. neural nets 2. support vector machines 3. principal component analyses E.A. Grigorenko, V.G. Amcheslavsky, S.B. Arsenyev, O.A. Mishulina, Integral indicator of acid-base balance in blood for assessment of patients with traumatic brain injury, Neotlozhnaya medicina 1. Meditzinsky alfavit 5 (221) (2014), 37–41.
6. Background Classification plot
7. Classifier 10 0 -10 Integral Homeostasis Index Good Bad output input pH pO2 pCO2 sO2 sBE Na K Ca Cl Lactate Bilirubin Hemoglobin Hematocrit Anions Glucose And… Background Integral Homeostasis Index (IHx)
8. The AIM The present work aims to determine the validity of the Integral Homeostasis Index (IHx), which is calculated from ABB blood test data, for the assessment and prognosis of the clinical state of children in critical trauma condition
9. Materials and Methods • 345 patients with severe mechanical trauma were included in the study • Average age 9 ± 6 years (1 month to 18 years), 218 (63.2%) boys, 127 (36.8%) girls • Average duration of stay in the ICU was 10 ± 4 days • In total, 7,322 ABB tests with calculation of IHx were carried out and in 1,414 tests the doctor’s expert comparison regarding the clinical state was performed
10. Materials and Methods • 32 patients were selected for further, more in-depth comparative analysis • 21 with positive outcome (according to GOS) • 11 with negative outcome (deep disability, vegetative state, or death) • An Arden-Syntax-based clinical decision support (CDS) platform was utilized to become part of the hospital’s ICU IT landscape
11. Results • From total amount of 1,414 expert evaluations in 1,374 cases, a positive correlation was obtained, which is more than 97%. • Further discriminant analysis allowed to obtain two classification equations: For subgroup 1(class 1): = 0.58*Mean+0.19*Variance−1.48 (For subgroup 2(class 2): = −1.08*Mean+0.55*Variance−6.51 Outcome % of correct classification Positive Outcome Negative Outcome Positive 100% 21 0 Negative 90.9% 1 10 Total 96.87% 22 10
12. Results Clinical example: positive outcome IHx Days Patient 6 years. Severe open head injury penetrating. Admission Glasgo 5, ISS 17 points. Positive dynamics of the state. Transfer to the profile Department in 10 days. Discharged on the 31st day with full recovery. Stable positive dynamics >24h Probability of negative outcome is < 12%
13. Results Clinical example: negative outcome IHx Days Patient G. 16 years. Traffic accident. Severe concomitant trauma. ISS 26 points, Glasgo 10 points. The increase in the severity of the condition on the background of CHP syndrome with fatal outcome on day 13. Steady decline in the index for >24h. Probability of fatal outcome is more than 83%
14. Results Clinical example: effect of HBO Patient F., 12 years old, female, admitted in coma after traffic accident. Heavy TBI and combined trauma, immediate implantation of intracranial pressure (ICP) sensor, increase of ICP up to 31 on the background of step therapy. On the 4th day, a bifrontal cerebral decompression was performed. The clinical state remained extremely critical, on the 6th day signs of systemic inflammation became apparent. On the 10th and 11th day, the first two sessions of hyperbaric oxygen therapy (HBO) were performed. The clinical picture started to improve. Later, two more HBO sessions were carried out. The result was more than favorable; the girl survived and was later discharged from hospital.
15. Results Decision Support System based on Arden Suite Engine
16. Conclusion • The developed technique confirms the high validity (97% of correct classification) of integrated homeostasis index (IHx) for assessment and prognosis of clinical state and outcome in children with severe mechanical trauma • A flexible and scalable CDS solution for intensive care based on Arden Syntax was developed, which forms an integral part in the total hospital information landscape
17. Thank you