Prediction of respiratory decompensation in Covid-19 patients using machine learning: The READY trial. (September 2020)

• Record Type: Journal Article
• Authors: Burdick, Hoyt; Lam, Carson; Mataraso, Samson; Siefkas, Anna; Braden, Gregory; Dellinger, R. Phillip; McCoy, Andrea; Vincent, Jean-Louis; Green-Saxena, Abigail; Barnes, Gina; Hoffman, Jana; Calvert, Jacob; Pellegrini, Emily; Das, Ritankar
• Is Part Of: Computers in biology and medicine. Volume 124(2020)
• Publication Date: 2020-09
• Subjects: Machine learning -- COVID-19 -- Mechanical ventilation -- Prediction; Medicine -- Data processing -- Periodicals; Biology -- Data processing -- Periodicals; 610.285
• DOI: 10.1016/j.compbiomed.2020.103949
• Languages: English
• ISSNs: 0010-4825

Abstract

Abstract: Background: Currently, physicians are limited in their ability to provide an accurate prognosis for COVID-19 positive patients. Existing scoring systems have been ineffective for identifying patient decompensation. Machine learning (ML) may offer an alternative strategy. A prospectively validated method to predict the need for ventilation in COVID-19 patients is essential to help triage patients, allocate resources, and prevent emergency intubations and their associated risks. Methods: In a multicenter clinical trial, we evaluated the performance of a machine learning algorithm for prediction of invasive mechanical ventilation of COVID-19 patients within 24 h of an initial encounter. We enrolled patients with a COVID-19 diagnosis who were admitted to five United States health systems between March 24 and May 4, 2020. Results: 197 patients were enrolled in the REspirAtory Decompensation and model for the triage of covid-19 patients: a prospective studY (READY) clinical trial. The algorithm had a higher diagnostic odds ratio (DOR, 12.58) for predicting ventilation than a comparator early warning system, the Modified Early Warning Score (MEWS). The algorithm also achieved significantly higher sensitivity (0.90) than MEWS, which achieved a sensitivity of 0.78, while maintaining a higher specificity (p < 0.05). Conclusions: In the first clinical trial of a machine learning algorithm for ventilation needs among COVID-19 patients, the algorithm demonstrated accurate prediction of the need for mechanical ventilation within 24 h. This algorithm may help care teams effectively triage patients and allocate resources. Further, the algorithm is capable of accurately identifying 16% more patients than a widely used scoring system while minimizing false positive results. Highlights: Validation of prediction algorithm for ventilation requirements in COVID-19 patients. Algorithm achieved significantly higher sensitivity than the common scoring system MEWS. Algorithm detected 16% more patients who will require invasive ventilation than MEWS. Advance warning of ventilation needs can help improve COVID-19 patient outcomes.