PLOS ONE | 2018-10-15

Validation of deep-learning-based triage and acuity score using a large national dataset


Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs. The NEDIS data was split into derivation data (January 2014-June 2016) and validation data (July-December 2016). We also used data from the Sejong General Hospital (SGH) for external validation (January-December 2017). We predicted in-hospital mortality, critical care, and hospitalization using initial information of ED patients (age, sex, chief complaint, time from symptom onset to ED visit, arrival mode, trauma, initial vital signs and mental status as predictor variables). A total of 11,656,559 patients were included in this study. The primary outcome was in-hospital mortality. The Area Under the Receiver Operating Characteristic curve (AUROC) and Area Under the Precision and Recall Curve (AUPRC) of DTAS were 0.935 and 0.264. It significantly outperformed Korean triage and acuity score (AUROC:0.785, AUPRC:0.192), modified early warning score (AUROC:0.810, AUPRC:0.116), logistic regression (AUROC:0.903, AUPRC:0.209), and random forest (AUROC:0.910, AUPRC:0.179). Deep-learning-based Triage and Acuity Score predicted in-hospital mortality, critical care, and hospitalization more accurately than existing triages and acuity, and it was validated using a large, multicenter dataset.
Journal of Digital Imaging | 2018-10-05

Towards Accurate Segmentation of Retinal Vessels and the Optic Disc in Fundoscopic Images with Generative Adversarial Networks.


Automatic segmentation of the retinal vasculature and the optic disc is a crucial task for accurate geometric analysis and reliable automated diagnosis. In recent years, Convolutional Neural Networks (CNN) have shown outstanding performance compared to the conventional approaches in the segmentation tasks. In this paper, we experimentally measure the performance gain for Generative Adversarial Networks (GAN) framework when applied to the segmentation tasks. We show that GAN achieves statistically significant improvement in area under the receiver operating characteristic (AU-ROC) and area under the precision and recall curve (AU-PR) on two public datasets (DRIVE, STARE) by segmenting fine vessels. Also, we found a model that surpassed the current state-of-the-art method by 0.2 − 1.0% in AU-ROC and 0.8 − 1.2% in AU-PR and 0.5 − 0.7% in dice coefficient. In contrast, significant improvements were not observed in the optic disc segmentation task on DRIONS-DB, RIM-ONE (r3) and Drishti-GS datasets in AU-ROC and AU-PR.
MICCAI LABELS 2018 | 2018-09-18

An Efficient and Comprehensive Labeling Tool for Large-Scale Annotation of Fundus Images


Computerized labeling tools are often used to systematically record the assessment for fundus images. Carefully designed labeling tools not only save time and enable comprehensive and thorough assessment at clinics, but also economize large-scale data collection processes for the development of automatic algorithms. To realize efficient and thorough fundus assessment, we developed a new labeling tool with novel schemes - stepwise labeling and regional encoding. We have used our tool in a large-scale data annotation project in which 318,376 annotations for 109,885 fundus images were gathered with a total duration of 421 h. We believe that the fundamental concepts in our tool would inspire other data collection processes and annotation procedure in different domains.
MICCAI OMIA 2018 | 2018-09-18

Classification of Findings with Localized Lesions in Fundoscopic Images using a Regionally Guided CNN


Fundoscopic images are often investigated by ophthalmologists to spot abnormal lesions to make diagnoses. Recent successes of convolutional neural networks are confined to diagnoses of few diseases without proper localization of lesion. In this paper, we propose an efficient annotation method for localizing lesions and a CNN architecture that can classify an individual finding and localize the lesions at the same time. Also, we introduce a new loss function to guide the network to learn meaningful patterns with the guidance of the regional annotations. In experiments, we demonstrate that our network performed better than the widely used network and the guidance loss helps achieve higher AUROC up to 4.1% and superior localization capability.
Acute and Critical Care | 2018-08-31

Deep Learning in the Medical Domain: Predicting Cardiac Arrest Using Deep Learning


With the wider adoption of electronic health records, the rapid response team initially believed that mortalities could be significantly reduced but due to low accuracy and false alarms, the healthcare system is currently fraught with many challenges. Rule-based methods (e.g., Modified Early Warning Score) and machine learning (e.g., random forest) were proposed as a solution but not effective. In this article, we introduce the DeepEWS (Deep learning based Early Warning Score), which is based on a novel deep learning algorithm. Relative to the standard of care and current solutions in the marketplace, there is high accuracy, and in the clinical setting even when we consider the number of alarms, the accuracy levels are superior.


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