Using predictive process monitoring to assist thrombolytic therapy decision-making for ischemic stroke patients

Abstract

Background: Although clinical guidelines provide the best practice for medical activities, there are some limitations in using clinical guidelines to assistant decision-making in practical application, such as long update cycle and low compliance of doctors with the guidelines. Driven by data of actual cases, process mining technology provides the possibility to remedy these shortcomings of clinical guidelines. Methods: We propose a clinical decision support method using predictive process monitoring, which could be complementary with clinical guidelines, to assist medical staff with thrombolytic therapy decision-making for stroke patients. Firstly, we construct a labeled data set of 1191 cases to show whether each case actually need thrombolytic therapy, and whether it conform to the clinical guidelines. After prefix extraction and filtering the control flow of completed cases, the sequences with data flow are encoded, and corresponding prediction models are trained. Results: Compared with the labeled results, the average accuracy of our prediction models for intravenous thrombolysis and arterial thrombolysis on the test set are 0.96 and 0.91, and AUC are 0.93 and 0.85 respectively. Compared with the recommendation of clinical guidelines, the accuracy, recall and AUC of our predictive models are higher. Conclusions: The performance and feasibility of this method are verified by taking thrombolytic decision-making of patients with ischemic stroke as an example. When the clinical guidelines are not applicable, doctors could be provided with assistant decision-making by referring to similar historical cases using predictive process monitoring.