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Exploring Artificial Intelligence in Emergency Medicine for Predicting Disposition, Death, and Diagnosis

Tolestam Heyman, Ellen LU orcid (2024) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
In the emergency department (ED), physicians and nurses make rapid, critical decisions. With the advancement of artificial intelligence (AI), we aimed to explore whether AI decision support could offer
clinical benefits in the ED.

Paper I: This study found no correlation between ED hospital admission likelihood and in-hospital bed occupancy levels, suggesting that previous findings may vary across hospitals, possibly due to differences in average hospital bed occupancy. Traditional statistical methods, not AI, were used in this paper.

Paper II: All-cause mortality is often used to predict end-of-life (EOL) and palliative care needs. We aimed to improve this AI prediction by means of an adjudicating committee,... (More)
In the emergency department (ED), physicians and nurses make rapid, critical decisions. With the advancement of artificial intelligence (AI), we aimed to explore whether AI decision support could offer
clinical benefits in the ED.

Paper I: This study found no correlation between ED hospital admission likelihood and in-hospital bed occupancy levels, suggesting that previous findings may vary across hospitals, possibly due to differences in average hospital bed occupancy. Traditional statistical methods, not AI, were used in this paper.

Paper II: All-cause mortality is often used to predict end-of-life (EOL) and palliative care needs. We aimed to improve this AI prediction by means of an adjudicating committee, excluding patients dying unexpectedly, such as in accidents, since these patients most likely lack needs for EOL care. When only unsurprising deaths were included, AI mortality prediction improved significantly.

Paper III: We developed an AI model to identify patients with acute heart failure (AHF), exacerbated chronic obstructive pulmonary disease (eCOPD), and pneumonia among dyspnoeic adults at the beginning of their ED visit. After manually reviewing a subsample of diagnoses, we analysed unselected data from a complete regional healthcare system. The model performed well, and each patient received their own unique set of variables, displayed interpretably.

Paper IV: Building on Paper III, we added electrocardiograms (ECGs) and socioeconomic data. Each patient’s unique set of variables was added to create an AI generated list of thousands of diagnostic variables. The list’s top 20 variables were included in a simpler model, which demonstrated high diagnostic ability, both with and without added medical expertise. (Less)
Abstract (Swedish)
In the emergency department (ED), physicians and nurses make rapid, critical decisions. With the advancement of artificial intelligence (AI), we aimed to explore whether AI decision support could offer
clinical benefits in the ED.

Paper I: This study found no correlation between ED hospital admission likelihood and in-hospital bed occupancy levels, suggesting that previous findings may vary across hospitals, possibly due to differences in average hospital bed occupancy. Traditional statistical methods, not AI, were used in this paper.

Paper II: All-cause mortality is often used to predict end-of-life (EOL) and palliative care needs. We aimed to improve this AI prediction by means of an adjudicating committee,... (More)
In the emergency department (ED), physicians and nurses make rapid, critical decisions. With the advancement of artificial intelligence (AI), we aimed to explore whether AI decision support could offer
clinical benefits in the ED.

Paper I: This study found no correlation between ED hospital admission likelihood and in-hospital bed occupancy levels, suggesting that previous findings may vary across hospitals, possibly due to differences in average hospital bed occupancy. Traditional statistical methods, not AI, were used in this paper.

Paper II: All-cause mortality is often used to predict end-of-life (EOL) and palliative care needs. We aimed to improve this AI prediction by means of an adjudicating committee, excluding patients dying unexpectedly, such as in accidents, since these patients most likely lack needs for EOL care. When
only unsurprising deaths were included, AI mortality prediction improved significantly.

Paper III: We developed an AI model to identify patients with acute heart failure (AHF), exacerbated chronic obstructive pulmonary disease (eCOPD), and pneumonia among dyspnoeic adults at the beginning of their ED visit. After manually reviewing a subsample of diagnoses, we analysed
unselected data from a complete regional healthcare system. The model performed well, and each patient received their own unique set of variables, displayed interpretably.

Paper IV: Building on Paper III, we added electrocardiograms (ECGs) and socioeconomic data. Each patient’s unique set of variables was added to create an AI generated list of thousands of diagnostic variables. The list’s top 20 variables were included in a simpler model, which demonstrated high diagnostic ability, both with and without added medical expertise. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Associate Professor Polesie, Sam, Sahlgrenska University Hospital
organization
alternative title
Prediktion av död, diagnos och inläggningsbeslut på akutmottagningen med hjälp av artificiell intelligens
publishing date
type
Thesis
publication status
published
subject
keywords
akutsjukvård, Akutmottagning, diagnostik, artificiell intelligens, maskininlärning, Dyspné, mortalitet, Emergency Medicine, Emergency department, Artifical Intelligence, machine learning (ML), Diagnostics, dyspnoea, mortality, disposition decision
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2024:128
pages
73 pages
publisher
Lund University, Faculty of Medicine
defense location
Belfragesalen, BMC D15, Klinikgatan 32 i Lund. Join by Zoom: https://lu-se.zoom.us/j/61949700061?pwd=HwX2yaDTBfyMKzz0b5PPUWTnXeT0w6.1
defense date
2024-11-21 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-626-5
project
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
d008abae-4b4c-4822-a38f-b1b1614a4b1b
date added to LUP
2024-10-24 17:35:45
date last changed
2024-11-05 14:41:57
@phdthesis{d008abae-4b4c-4822-a38f-b1b1614a4b1b,
  abstract     = {{In the emergency department (ED), physicians and nurses make rapid, critical decisions. With the advancement of artificial intelligence (AI), we aimed to explore whether AI decision support could offer <br/>clinical benefits in the ED. <br/><br/>Paper I: This study found no correlation between ED hospital admission likelihood and in-hospital bed occupancy levels, suggesting that previous findings may vary across hospitals, possibly due to differences in average hospital bed occupancy. Traditional statistical methods, not AI, were used in this paper. <br/><br/>Paper II: All-cause mortality is often used to predict end-of-life (EOL) and palliative care needs. We aimed to improve this AI prediction by means of an adjudicating committee, excluding patients dying unexpectedly, such as in accidents, since these patients most likely lack needs for EOL care. When only unsurprising deaths were included, AI mortality prediction improved significantly. <br/><br/>Paper III: We developed an AI model to identify patients with acute heart failure (AHF), exacerbated chronic obstructive pulmonary disease (eCOPD), and pneumonia among dyspnoeic adults at the beginning of their ED visit. After manually reviewing a subsample of diagnoses, we analysed unselected data from a complete regional healthcare system. The model performed well, and each patient received their own unique set of variables, displayed interpretably. <br/><br/>Paper IV: Building on Paper III, we added electrocardiograms (ECGs) and socioeconomic data. Each patient’s unique set of variables was added to create an AI generated list of thousands of diagnostic variables. The list’s top 20 variables were included in a simpler model, which demonstrated high diagnostic ability, both with and without added medical expertise.}},
  author       = {{Tolestam Heyman, Ellen}},
  isbn         = {{978-91-8021-626-5}},
  issn         = {{1652-8220}},
  keywords     = {{akutsjukvård; Akutmottagning; diagnostik; artificiell intelligens; maskininlärning; Dyspné; mortalitet; Emergency Medicine; Emergency department; Artifical Intelligence; machine learning (ML); Diagnostics; dyspnoea; mortality; disposition decision}},
  language     = {{eng}},
  number       = {{2024:128}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Exploring Artificial Intelligence in Emergency Medicine for Predicting Disposition, Death, and Diagnosis}},
  url          = {{https://lup.lub.lu.se/search/files/198535505/ETH_LUCRIS.pdf}},
  year         = {{2024}},
}