Identification of physiological shock in intensive care units via Bayesian regime switching models

TL;DR

This paper introduces a Bayesian regime switching model to detect occult hemorrhage early in ICU patients by analyzing vital signs and labs, improving timely diagnosis and intervention.

Contribution

The study develops a novel Bayesian regime switching model with a new sampling routine for early hemorrhage detection in ICU patients using real-world data.

Findings

Effective detection of hemorrhage in ICU patients demonstrated

Model accurately captures physiological state transitions

Real case study validates approach

Abstract

Detection of occult hemorrhage (i.e., internal bleeding) in patients in intensive care units (ICUs) can pose significant challenges for critical care workers. Because blood loss may not always be clinically apparent, clinicians rely on monitoring vital signs for specific trends indicative of a hemorrhage event. The inherent difficulties of diagnosing such an event can lead to late intervention by clinicians which has catastrophic consequences. Therefore, a methodology for early detection of hemorrhage has wide utility. We develop a Bayesian regime switching model (RSM) that analyzes trends in patients' vitals and labs to provide a probabilistic assessment of the underlying physiological state that a patient is in at any given time. This article is motivated by a comprehensive dataset we curated from Mayo Clinic of 33,924 real ICU patient encounters. Longitudinal response measurements are modeled as a vector autoregressive process conditional on all latent states up to the current time point, and the latent states follow a Markov process. We present a novel Bayesian sampling routine to learn the posterior probability distribution of the latent physiological states, as well as develop an approach to account for pre-ICU-admission physiological changes. A simulation and real case study illustrate the effectiveness of our approach.