揭示数字过度诊断 - 使用临床轨迹进行量化和减轻:肝素诱导的血小板缺血使用案例
Prabodi Senevirathna1, Douglas E V Pires1, Daniel Capurro2
1School of Computing and Information Systems, The University of Melbourne, Melbourne 3053 Victoria, Australia.
Journal of biomedical informatics
|July 10, 2025
概括
本研究引入了一种机器学习框架,通过整合临床数据来量化和减少数字过度诊断. 该方法成功识别和重新分类过度诊断的病例,提高了诊断准确度.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健中的机器学习
- 临床决策支持系统 临床决策支持系统
背景情况:
- 过度诊断,即识别无症状疾病,在数字诊断方面构成了挑战.
- 量化和减轻过度诊断的现有数据驱动框架是有限的.
- 肝素诱导的血小板缺血 (HIT) 是数字过度诊断的一个案例研究.
研究的目的:
- 开发和验证一种用于量化和减轻数字过度诊断的新型框架.
- 将临床轨迹集成到机器学习 (ML) 分类器中,以提高诊断准确度.
- 使用HIT作为一个模型来证明框架的有效性.
主要方法:
- 使用了先前存在的HIT分类器,基于HIT诊断标准的地面真相.
- 真正阳性 (TP) 和真正阴性 (TN) 患者的临床轨迹使用基于过程模型的方法进行了聚类.
- 当TP病例与TN病例聚集在一起时,发现了过度诊断;分类器被重新训练了更新的标签.
主要成果:
- 7.2%的TP病例被确定为过度诊断.
- 重新培训成功地将89.5%的过度诊断病例重新归类为TN,其性能降低最小.
- 在非过度诊断和过度诊断/TN病例之间,临床结果有显著差异,证实过度诊断的患者与TN患者相似.
结论:
- 将临床轨迹集成到基于ML的诊断中,可以有效量化数字过度诊断.
- 这种方法通过在监督学习中重新评估基于标准的疾病标签来改进ML算法.
- 该框架提供了一条减少数字健康工具过度诊断的途径.
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