Predicting adverse outcomes for febrile patients in the emergency department using sparse laboratory data: Development of a time adaptive model

Abstract

Background: A timely decision in the initial stages for patients with an acute illness is important. However, only a few studies have determined the prognosis of patients based on insufficient laboratory data during the initial stages of treatment. Objective: This study aimed to develop and validate time adaptive prediction models to predict the severity of illness in the emergency department (ED) using highly sparse laboratory test data (test order status and test results) and a machine learning approach. Methods: This retrospective study used ED data from a tertiary academic hospital in Seoul, Korea. Two different models were developed based on laboratory test data: order status only (OSO) and order status and results (OSR) models. A binary composite adverse outcome was used, including mortality or hospitalization in the intensive care unit. Both models were evaluated using various performance criteria, including the area under the receiver operating characteristic curve (AUC) and balanced accuracy (BA). Clinical usefulness was examined by determining the positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Results: Of 9491 eligible patients in the ED (mean age, 55.2 years, SD 17.7 years; 4839/9491, 51.0% women), the model development cohort and validation cohort included 6645 and 2846 patients, respectively. The OSR model generally exhibited better performance (AUC=0.88, BA=0.81) than the OSO model (AUC=0.80, BA=0.74). The OSR model was more informative than the OSO model to predict patients at low or high risk of adverse outcomes (P