Machine learning models predicting undertriage in telephone triage
Background Undertriaged patients have worse outcomes than appropriately triaged patients. Machine learning provides better triage prediction than conventional triage in emergency departments, but no machine learning-based undertriage prediction models have yet been developed for prehospital telephon...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2022.2136402 |
| _version_ | 1811245295833448448 |
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| author | Ryota Inokuchi Masao Iwagami Yu Sun Ayaka Sakamoto Nanako Tamiya |
| author_facet | Ryota Inokuchi Masao Iwagami Yu Sun Ayaka Sakamoto Nanako Tamiya |
| author_sort | Ryota Inokuchi |
| collection | DOAJ |
| description | Background Undertriaged patients have worse outcomes than appropriately triaged patients. Machine learning provides better triage prediction than conventional triage in emergency departments, but no machine learning-based undertriage prediction models have yet been developed for prehospital telephone triage. We developed and validated machine learning models for telephone triage.Materials and methods We conducted a retrospective cohort study with the largest after-hour house-call (AHHC) service dataset in Japan. Participants were ≥16 years and used the AHHC service between 1 November 2018 and 31 January 2021. We developed five prediction models based on support vector machine (SVM), lasso regression (LR), random forest (RF), gradient-boosted decision tree (XGB), and deep neural network (DNN). The primary outcome was undertriage, and predictors were telephone triage level and routinely available telephone-based data, including age, sex, 80 chief complaint categories and 10 comorbidities. We measured the area under the receiver operating characteristic curve (AUROC) for all the models.Results We identified 15,442 eligible patients (age: 38.4 ± 16.6, male: 57.2%), including 298 (1.9%; age: 58.2 ± 23.9, male: 55.0%) undertriaged patients. RF and XGB outperformed the other models, with the AUROC values (95% confidence interval; 95% CI) of the SVM, LR, RF, XGB and DNN for undertriage being 0.62 (0.55–0.69), 0.79 (0.74–0.83), 0.81 (0.76–0.86), 0.80 (0.75–0.84) and 0.77 (0.73–0.82), respectively.Conclusions We found that RF and XGB outperformed other models. Our findings suggest that machine learning models can facilitate the early detection of undertriage and early intervention to yield substantially improved patient outcomes.KEY MESSAGESUndertriaged patients experience worse outcomes than appropriately triaged patients; thus, we developed machine learning models for predicting undertriage in the prehospital setting. In addition, we identified the predictors of risk factors associated with undertriage.Random forest and gradient-boosted decision tree models demonstrated better prediction performance, and the models identified the risk factors associated with undertriage.Machine learning models aid in the early detection of undertriage, leading to significantly improved patient outcomes and identifying undertriage-associated risk factors, including chief complaint categories, could help prioritize conventional telephone triage protocol revision. |
| first_indexed | 2024-04-12T14:37:36Z |
| format | Article |
| id | doaj.art-f9d5818dbcce4efda2c6a1d0a468b4e4 |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-04-12T14:37:36Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj.art-f9d5818dbcce4efda2c6a1d0a468b4e42022-12-22T03:29:02ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602022-12-015412990299710.1080/07853890.2022.2136402Machine learning models predicting undertriage in telephone triageRyota Inokuchi0Masao Iwagami1Yu Sun2Ayaka Sakamoto3Nanako Tamiya4Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanHealth Services Research and Development Center, University of Tsukuba, Tsukuba, JapanHealth Services Research and Development Center, University of Tsukuba, Tsukuba, JapanDepartment of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanBackground Undertriaged patients have worse outcomes than appropriately triaged patients. Machine learning provides better triage prediction than conventional triage in emergency departments, but no machine learning-based undertriage prediction models have yet been developed for prehospital telephone triage. We developed and validated machine learning models for telephone triage.Materials and methods We conducted a retrospective cohort study with the largest after-hour house-call (AHHC) service dataset in Japan. Participants were ≥16 years and used the AHHC service between 1 November 2018 and 31 January 2021. We developed five prediction models based on support vector machine (SVM), lasso regression (LR), random forest (RF), gradient-boosted decision tree (XGB), and deep neural network (DNN). The primary outcome was undertriage, and predictors were telephone triage level and routinely available telephone-based data, including age, sex, 80 chief complaint categories and 10 comorbidities. We measured the area under the receiver operating characteristic curve (AUROC) for all the models.Results We identified 15,442 eligible patients (age: 38.4 ± 16.6, male: 57.2%), including 298 (1.9%; age: 58.2 ± 23.9, male: 55.0%) undertriaged patients. RF and XGB outperformed the other models, with the AUROC values (95% confidence interval; 95% CI) of the SVM, LR, RF, XGB and DNN for undertriage being 0.62 (0.55–0.69), 0.79 (0.74–0.83), 0.81 (0.76–0.86), 0.80 (0.75–0.84) and 0.77 (0.73–0.82), respectively.Conclusions We found that RF and XGB outperformed other models. Our findings suggest that machine learning models can facilitate the early detection of undertriage and early intervention to yield substantially improved patient outcomes.KEY MESSAGESUndertriaged patients experience worse outcomes than appropriately triaged patients; thus, we developed machine learning models for predicting undertriage in the prehospital setting. In addition, we identified the predictors of risk factors associated with undertriage.Random forest and gradient-boosted decision tree models demonstrated better prediction performance, and the models identified the risk factors associated with undertriage.Machine learning models aid in the early detection of undertriage, leading to significantly improved patient outcomes and identifying undertriage-associated risk factors, including chief complaint categories, could help prioritize conventional telephone triage protocol revision.https://www.tandfonline.com/doi/10.1080/07853890.2022.2136402Prehospitalafter-hours house-call medical serviceout-of-hour serviceprediction |
| spellingShingle | Ryota Inokuchi Masao Iwagami Yu Sun Ayaka Sakamoto Nanako Tamiya Machine learning models predicting undertriage in telephone triage Annals of Medicine Prehospital after-hours house-call medical service out-of-hour service prediction |
| title | Machine learning models predicting undertriage in telephone triage |
| title_full | Machine learning models predicting undertriage in telephone triage |
| title_fullStr | Machine learning models predicting undertriage in telephone triage |
| title_full_unstemmed | Machine learning models predicting undertriage in telephone triage |
| title_short | Machine learning models predicting undertriage in telephone triage |
| title_sort | machine learning models predicting undertriage in telephone triage |
| topic | Prehospital after-hours house-call medical service out-of-hour service prediction |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2022.2136402 |
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