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Clinical Deterioration Prediction in Brazilian Hospitals Based on Artificial Neural Networks and Tree Decision Models

Early recognition of clinical deterioration (CD) has vital importance in patients' survival from exacerbation or death. Electronic health records (EHRs) data have been widely employed in Early Warning Scores (EWS) to measure CD risk in hospitalized patients. Recently, EHRs data have been utilized in Machine Learning (ML) models to predict mortality and CD. The ML models have shown superior performance in CD prediction compared to EWS. Since EHRs data are structured and tabular, conventional ML models are generally applied to them, and less effort is put into evaluating the artificial neural network's performance on EHRs data. Thus, in this article, an extremely boosted neural network (XBNet) is used to predict CD, and its performance is compared to eXtreme Gradient Boosting (XGBoost) and random forest (RF) models. For this purpose, 103,105 samples from thirteen Brazilian hospitals are used to generate the models. Moreover, the principal component analysis (PCA) is employed to verify whether it can improve the adopted models' performance. The performance of ML models and Modified Early Warning Score (MEWS), an EWS candidate, are evaluated in CD prediction regarding the accuracy, precision, recall, F1-score, and geometric mean (G-mean) metrics in a 10-fold cross-validation approach. According to the experiments, the XGBoost model obtained the best results in predicting CD among Brazilian hospitals' data.

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