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Learning Data-Driven Patient Risk Stratification Models for Clostridium difficile.

MedStar author(s):

Citation: Open Forum Infectious Diseases. 1(2):ofu045, 2014 Sep.PMID: 25734117Institution: MedStar Institute for Innovation | MedStar Union Memorial HospitalForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2014 ISSN:

2328-8957

Name of journal: Open forum infectious diseasesAbstract: BACKGROUND: Although many risk factors are well known, Clostridium difficile infection (CDI) continues to be a significant problem throughout the world. The purpose of this study was to develop and validate a data-driven, hospital-specific risk stratification procedure for estimating the probability that an inpatient will test positive for C difficile.CONCLUSIONS: Automated risk stratification of patients based on the contents of their EMRs can be used to accurately identify a high-risk population of patients. The proposed method holds promise for enabling the selective allocation of interventions aimed at reducing the rate of CDI.METHODS: We consider electronic medical record (EMR) data from patients admitted for >=24 hours to a large urban hospital in the U.S. between April 2011 and April 2013. Predictive models were constructed using L2-regularized logistic regression and data from the first year. The number of observational variables considered varied from a small set of well known risk factors readily available to a physician to over 10 000 variables automatically extracted from the EMR. Each model was evaluated on holdout admission data from the following year. A total of 34 846 admissions with 372 cases of CDI was used to train the model.RESULTS: Applied to the separate validation set of 34 722 admissions with 355 cases of CDI, the model that made use of the additional EMR data yielded an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% confidence interval [CI], .79-.83), and it significantly outperformed the model that considered only the small set of known clinical risk factors, AUROC of 0.71 (95% CI, .69-.75).All authors: Campbell WN, Franklin ES, Guttag JV, Horvitz E, Wiens JFiscal year: FY2015Digital Object Identifier:

https://dx.doi.org/10.1093/ofid/ofu045

Date added to catalog: 2020-12-29

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Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	25734117	Available		25734117

BACKGROUND: Although many risk factors are well known, Clostridium difficile infection (CDI) continues to be a significant problem throughout the world. The purpose of this study was to develop and validate a data-driven, hospital-specific risk stratification procedure for estimating the probability that an inpatient will test positive for C difficile.

CONCLUSIONS: Automated risk stratification of patients based on the contents of their EMRs can be used to accurately identify a high-risk population of patients. The proposed method holds promise for enabling the selective allocation of interventions aimed at reducing the rate of CDI.

METHODS: We consider electronic medical record (EMR) data from patients admitted for >=24 hours to a large urban hospital in the U.S. between April 2011 and April 2013. Predictive models were constructed using L2-regularized logistic regression and data from the first year. The number of observational variables considered varied from a small set of well known risk factors readily available to a physician to over 10 000 variables automatically extracted from the EMR. Each model was evaluated on holdout admission data from the following year. A total of 34 846 admissions with 372 cases of CDI was used to train the model.

RESULTS: Applied to the separate validation set of 34 722 admissions with 355 cases of CDI, the model that made use of the additional EMR data yielded an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% confidence interval [CI], .79-.83), and it significantly outperformed the model that considered only the small set of known clinical risk factors, AUROC of 0.71 (95% CI, .69-.75).

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