Pediatric Intensive Care Unit Length of Stay Prediction by Machine Learning

Purpose: To develop and validate machine learning models for predicting the length of stay (LOS) in the Pediatric Intensive Care Unit (PICU) using data from the Virtual Pediatric Systems (VPS) database. Methods: A retrospective study was conducted utilizing machine learning (ML) algorithms to analyze and predict PICU LOS based on historical patient data from the VPS database. The study included data from over 100 North American PICUs spanning the years 2015-2020. After excluding entries with missing variables and those indicating recovery from cardiac surgery, the dataset comprised 123,354 patient encounters. Various ML models, including Support Vector Machine, Stochastic Gradient Descent Classifier, K-Nearest Neighbors, Decision Tree, Gradient Boosting, CatBoost, and Recurrent Neural Networks (RNNs), were evaluated for their accuracy in predicting PICU LOS at thresholds of 24 h, 36 h, 48 h, 72 h, 5 days, and 7 days. Results: Gradient Boosting, CatBoost, and RNN models demonstrated the highest accuracy, particularly at the 36 h and 48 h thresholds, with accuracy rates between 70 and 73%. These results far outperform traditional statistical and existing prediction methods that report accuracy of only around 50%, which is effectively unusable in the practical setting. These models also exhibited balanced performance between sensitivity (up to 74%) and specificity (up to 82%) at these thresholds. Conclusions: ML models, particularly Gradient Boosting, CatBoost, and RNNs, show moderate effectiveness in predicting PICU LOS with accuracy slightly over 70%, outperforming previously reported human predictions. This suggests potential utility in enhancing resource and staffing management in PICUs. However, further improvements through training on specialized databases can potentially achieve better accuracy and clinical applicability.