Key result
Artificial neural network model predicts MACE in ED triage with 0.97 AUC.
Why the study?
The study was designed to evaluate an artificial neural network model using a systemic grid search for early prediction of MACE among patients presenting to emergency department triage.
Does an Artificial Neural Network model using triage data improve the prediction of major adverse cardiac events in adults presenting to the emergency department with cardiovascular symptoms?
Cross-Sectional (n=97,333)
No
Does an Artificial Neural Network model using triage data improve the prediction of major adverse cardiac events in adults presenting to the emergency department with cardiovascular symptoms?
Effect estimate: AUC 0.97
Absolute Event Rate: 0.97% vs 0.96%
An Artificial Neural Network model using triage data accurately predicts major adverse cardiac events, in-hospital mortality, and cardiac arrest in emergency department patients with cardiovascular symptoms.
BACKGROUND: The aim of our research was to design and evaluate an Artificial Neural Network (ANN) model using a systemic grid search for the early prediction of major adverse cardiac events (MACE) among patients presenting to the triage of an emergency department. METHODS: This is a single-center, cross-sectional study using electronic health records from January 2017 to December 2020. The research population consists of adults coming to our emergency department triage at Aga Khan University Hospital. The MACE during hospitalization was the main outcome. To enhance the architecture of an ANN using triage data, we used a systematic grid search strategy. Four hidden ANN layers were used, followed by an output layer. Following each hidden layer was back normalization and a dropout layer. MACE was predicted using three binary classifiers: ANN, Random Forests (RF), and logistic regression (LR). The overall accuracy, sensitivity, specificity, precision, and recall of these models were examined. Each model was evaluated using the receiver operating characteristic curve (ROC) and an F1-score with a 95% confidence interval. RESULTS: A total of 97,333 emergency department visits were recorded during the study period, with 33% of patients having cardiovascular symptoms. The mean age was 54.08 (19.18) years old. The MACE was observed in 23,052 (23.7%) of the patients, in-hospital (up to 30 days) mortality in 10,888 (11.2%) patients, and cardiac arrest in 5483 (5.6%) patients. The data used for training and validation were 77,866 and 19,467 in an 80:20 ratio, respectively. The AUC score for MACE with ANN was 0.97, which was greater than RF (0.96) and LR (0.96). Similarly, the precision-recall curve for MACE utilizing ANN was greater (0.94 vs. 0.93 for RF and 0.93 for LR). The sensitivity for MACE prediction using ANN, RF, and LR classifiers was 99.3%, 99.4%, and 99.2%, respectively, with the specificities being 94.5%, 94.2%, and 94.2%, respectively. CONCLUSION: When triage data is used to predict MACE, death, and cardiac arrest, ANN with systemic grid search gives precise and valid outcomes and will benefit in predicting MACE in emergency rooms with limited resources that have to deal with a substantial number of patients.
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Raheem et al. (2024) conducted a cross-sectional in Cardiovascular symptoms (n=97,333). Artificial Neural Network (ANN) vs. Random Forests (RF) and Logistic Regression (LR) was evaluated on Major adverse cardiac events (MACE) (AUC 0.97). An artificial neural network model using systematic grid search predicted major adverse cardiac events in emergency department triage with an AUC of 0.97.
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