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Published on: January 30, 2018
Optimizing Vital Signs in Patients With Traumatic Brain Injury: Reinforcement Learning Algorithm Development and
Hongwei Zhang1, Mengyuan Diao1, Sheng Zhang2
1Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, 261 Huansha Road, Hangzhou, 310006, China, 86 13634164536.
Background:
Traumatic brain injury (TBI) is a critically ill disease with a high mortality rate, and clinical treatment is committed to continuously optimizing treatment strategies to improve survival rates.
Objective:
This study aims to establish a reinforcement learning algorithm (RL) to optimize the survival prognosis decision-making scheme for patients with TBI in the intensive care unit.
Methods:
We included a total of 2745 patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database and randomly divided them into a training set and an internal validation set at 8:2. We extracted 34 features for analysis and modeling using a 2-hour time compensation, 2 action features (mean arterial pressure and temperature), and 1 outcome feature (survival status at 28 d). We used an RL algorithm called weighted dueling double deep Q-network with embedded human expertise to maximize cumulative returns and evaluated the model using a doubly robust off-policy evaluation method. Finally, we collected 2463 patients with TBI from MIMIC III as an external validation set to test the model.
Results:
The action features are divided into 6 intervals, and the expected benefits are estimated using a doubly robust off-policy evaluation method. The results indicate that the survival rate of artificial intelligence (AI) strategies is higher than that of clinical doctors (88.016%, 95% CI 85.191%-90.840% vs 81.094%, 95% CI 80.422%-81.765%), with an expected return of 28.978 (95% CI 28.797-29.160) versus 27.092 (95% CI 24.584-29.600). Compared with clinical doctors, AI algorithms select normal temperatures more frequently (36.56 °C to 36.83 ℃) and recommend mean arterial pressure levels of 87.5-95.0 mm Hg. In external validation, the AI strategy still has a high survival rate of 87.565%, with an expected return of 27.517.
Conclusions:
This RL algorithm for patients with TBI indicates that a more personalized and targeted optimization of the vital signs is possible. This algorithm will assist clinicians in making decisions on an individualized patient-by-patient basis.
