Chinese researchers from Trauma Center, Peking University People's Hospital and National Institute of Health Data Science of Peking University are using big data to help identify trauma patients who could experience potential adverse health events in the emergency department through the aid of a clinical decision support system. It was developed using a novel real-world evidence mining and evidence-based inference method, driven by improved information storage and electronic medical records.
The researchers published their results online on February 7 in IEEE Transactions on Systems, Man, and Cybernetics: Systems, a journal of the Institute of Electrical and Electronics Engineers. This is the first clinical decision support systems developed using evidential reasoning in an emergency department setting.
"Appropriate use of information technologies, particularly clinical decision support systems, may aid clinicians to make better clinical decisions and reduce the rate of medical errors," said the corresponding author Baoguo Jiang, Director at theTrauma Center, Peking University People's Hospital. "By inputting clinical data of a patient, combined with available historical data, our proposed clinical decision support system outputs a predicted belief degree of severe trauma, including ICU admission and in-hospital death."
"The clinical variable signs and symptoms may be interrelated and lead to a clinical outcome. For example, a patient may have low level of consciousness because of the location of the injury, or it might be related to the high body temperature". In developing their clinical decision support system, the first author Dr. Guilan Kong used a trauma dataset from the emergency department at Kailuan Hospital in China, a hospital that has a close research collaboration with the Trauma Center, Peking University People's Hospital. Through the dataset, the researchers obtained the data of 1,299 trauma patients. The degree of interdependence between clinical signs and symptoms can be calculated from historical patient data. In the proposed clinical decision support system, the emergency room physician supplies information about the patient, including blood pressure, pulse rate, respiration rate, consciousness level, body temperature, age, comorbidities, mechanism and location of injury. These clinical signs and symptoms are then processed using an evidential reasoning rule, which compares each piece against the evidence mined from real-world data to predict the probability of adverse events and to optimally manage trauma patients and help them achieve ideal outcomes, trauma patients with a high probability of being admitted to the intensive care unit or dying in hospital need to be identified quickly and accurately upon their arrival at a hospital.
The team found that not only did their model prove especially useful in cases without prior expert knowledge or clinical experiences, but that the clinical decision support system also allowed for more accurate identification of trauma patients with adverse events compared to other systems with traditional machine learning models. Furthermore, the clinical decision support system works in a real-time fashion. From a physician's input of a patient's data to generating appropriate advices, the system works almost without any delay, which in turn helps buy trauma patients valuable time.
Next, the researchers plan to finetune their system and to generalize it for use in other clinical areas and non-emergent department settings.
Other contributors include Professor Tianbing Wang, who is affiliated with the Trauma Center, Peking University People's Hospital, and Dongling Xu and Jianbo Yang, who are affiliated with the Decision and Cognitive Sciences Research Centre of the University of Manchester.
This work was supported in part by the National Natural Science Foundation, the Peking University in China and the National Natural Science Foundation-Zhejiang Joint Fund for the Integration of Industrialization and Informatization.
China's National Center for Trauma Medicine is the only national standardized treatment and training center for severe trauma approved by China's National Health Commission in September 2019, which is mainly supported by Peking University People's Hospital. The center has developed China's first professional treatment standards for severe trauma. It also establishes a closed-loop regional trauma treatment system, with the general hospital as the core of the system, which is called the Chinese model of standardized severe trauma treatment system by the specialists in the academic field.