Automated remote decision-making algorithm as a primary triage system using machine learning techniques

An objective and convenient primary triage procedure is needed for prioritizing patients who need help in mass casualty incident (MCI) situations, where there is a lack of medical staff and available resources. This study aimed to develop an automated remote decision-making algorithm that remotely categorize a patient's emergency level using clinical parameters that can be measured with a wearable device.

The algorithm was developed according to the following procedures. First, we used the National Trauma Data Bank data set, a large open trauma patient data set assembled by the American College of Surgeons (ACS). In addition, we performed pre-processing to exclude data when the vital sign or consciousness indicator value was missing or physiologically in an abnormal range. Second, we selected the T-RTS method, which classifies emergency levels into four classes (Delayed, Urgent, Immediate and Dead), as the primary outcome. Third, three machine learning methods widely used in the medical field, logistic regression, random forest, and deep neural network (DNN), were applied to build the algorithm. Finally, each method was evaluated using quantitative performance indicators including the macro-averaged f1 score, macro-averaged mean absolute error (MMAE), and the area under the receiver operating characteristic curve (AUC).

For total sets, the logistic regression had a macro-averaged f1 score of 0.673, an MMAE of 0.387 and an AUC value of 0.844 (95% CI, 0.843-0.845), while the random forest and DNN had macro-averaged f1 scores of 0.783 and 0.784, MMAEs of 0.297 and 0.298 and AUC values of 0.882 (95% CI, 0.881-0.883) and 0.883(95% CI, 0.881-0.884), respectively.

In a comprehensive analysis of these results, our algorithm demonstrated a viable approach that could be practically adopted in an MCI. In addition, it can be employed to transfer patients and to redistribute available resources according to their priorities.