Deep learning predicts extreme preterm birth from electronic health records

Gao, Cheng; Osmundson, Sarah S.; Edwards, Digna R. Velez; Jackson, Gretchen Purcell; Malin, Bradley; Chen, You

doi:10.1016/j.jbi.2019.103334

Cited by 69 publications

(72 citation statements)

References 48 publications

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“…As applicability was already included in the eligibility assessment before the qualitative analysis, eligible studies were not found to use data sets from either primary care or hospital settings, such as from a house-to-house survey or a screening program. Most used data sets were from hospital settings, whereas only a few of those were from primary care settings in the LR (6/77, 8%) [65,69,73,77,78,87], non-LR (6/50, 12%) [119,122,132,135,148,153], or both algorithms (1/15, 7%) [162]. A detailed description of this is also given in Multimedia Appendix 1.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Comparison of Multivariable Logistic Regression and Other Machine Learning Algorithms for Prognostic Prediction Studies in Pregnancy Care: Systematic Review and Meta-Analysis

et al. 2020

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Background Predictions in pregnancy care are complex because of interactions among multiple factors. Hence, pregnancy outcomes are not easily predicted by a single predictor using only one algorithm or modeling method. Objective This study aims to review and compare the predictive performances between logistic regression (LR) and other machine learning algorithms for developing or validating a multivariable prognostic prediction model for pregnancy care to inform clinicians’ decision making. Methods Research articles from MEDLINE, Scopus, Web of Science, and Google Scholar were reviewed following several guidelines for a prognostic prediction study, including a risk of bias (ROB) assessment. We report the results based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were primarily framed as PICOTS (population, index, comparator, outcomes, timing, and setting): Population: men or women in procreative management, pregnant women, and fetuses or newborns; Index: multivariable prognostic prediction models using non-LR algorithms for risk classification to inform clinicians’ decision making; Comparator: the models applying an LR; Outcomes: pregnancy-related outcomes of procreation or pregnancy outcomes for pregnant women and fetuses or newborns; Timing: pre-, inter-, and peripregnancy periods (predictors), at the pregnancy, delivery, and either puerperal or neonatal period (outcome), and either short- or long-term prognoses (time interval); and Setting: primary care or hospital. The results were synthesized by reporting study characteristics and ROBs and by random effects modeling of the difference of the logit area under the receiver operating characteristic curve of each non-LR model compared with the LR model for the same pregnancy outcomes. We also reported between-study heterogeneity by using τ2 and I2. Results Of the 2093 records, we included 142 studies for the systematic review and 62 studies for a meta-analysis. Most prediction models used LR (92/142, 64.8%) and artificial neural networks (20/142, 14.1%) among non-LR algorithms. Only 16.9% (24/142) of studies had a low ROB. A total of 2 non-LR algorithms from low ROB studies significantly outperformed LR. The first algorithm was a random forest for preterm delivery (logit AUROC 2.51, 95% CI 1.49-3.53; I2=86%; τ2=0.77) and pre-eclampsia (logit AUROC 1.2, 95% CI 0.72-1.67; I2=75%; τ2=0.09). The second algorithm was gradient boosting for cesarean section (logit AUROC 2.26, 95% CI 1.39-3.13; I2=75%; τ2=0.43) and gestational diabetes (logit AUROC 1.03, 95% CI 0.69-1.37; I2=83%; τ2=0.07). Conclusions Prediction models with the best performances across studies were not necessarily those that used LR but also used random forest and gradient boosting that also performed well. We recommend a reanalysis of existing LR models for several pregnancy outcomes by comparing them with those algorithms that apply standard guidelines. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42019136106; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136106

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Section: Characteristics Of the Studiesmentioning

confidence: 99%

Comparison of Multivariable Logistic Regression and Other Machine Learning Algorithms for Prognostic Prediction Studies in Pregnancy Care: Systematic Review and Meta-Analysis

et al. 2020

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“…Acquiring big data that is also high quality is essential for these cutting-edge approaches to be effective and, for this reason, there is little or no such endeavor in case big data is not available (as for preterm birth). However, this situation might change and more effort needs to be made in this direction, given an increasing amount of publication on this topic in very recent years [46,47].…”

Section: Application Of Deep Learning In Early Diagnosis Of Spontaneomentioning

confidence: 99%

“…For example, a recent study used a recurrent neural network ensemble to predict extreme preterm birth (birth before the 28th week of gestational age) [46]. Data for this study came from electronic health records on 25,689 deliveries at the Vanderbilt University Medical Center.…”

Section: Application Of Deep Learning In Early Diagnosis Of Spontaneomentioning

confidence: 99%

Application of Artificial Intelligence in Early Diagnosis of Spontaneous Preterm Labor and Birth

Lee

Ahn

2020

Diagnostics

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This study reviews the current status and future prospective of knowledge on the use of artificial intelligence for the prediction of spontaneous preterm labor and birth (“preterm birth” hereafter). The summary of review suggests that different machine learning approaches would be optimal for different types of data regarding the prediction of preterm birth: the artificial neural network, logistic regression and/or the random forest for numeric data; the support vector machine for electrohysterogram data; the recurrent neural network for text data; and the convolutional neural network for image data. The ranges of performance measures were 0.79–0.94 for accuracy, 0.22–0.97 for sensitivity, 0.86–1.00 for specificity, and 0.54–0.83 for the area under the receiver operating characteristic curve. The following maternal variables were reported to be major determinants of preterm birth: delivery and pregestational body mass index, age, parity, predelivery systolic and diastolic blood pressure, twins, below high school graduation, infant sex, prior preterm birth, progesterone medication history, upper gastrointestinal tract symptom, gastroesophageal reflux disease, Helicobacter pylori, urban region, calcium channel blocker medication history, gestational diabetes mellitus, prior cone biopsy, cervical length, myomas and adenomyosis, insurance, marriage, religion, systemic lupus erythematosus, hydroxychloroquine sulfate, and increased cerebrospinal fluid and reduced cortical folding due to impaired brain growth.

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“…However, using logistic regression to predict low prevalence events may lead to meaningless outcomes [12]. Data augmentation by up-sampling randomly increases the number of positive preterm birth pro les in the newly generated dataset without changing the other class comprising women not presenting PTB [13]. This technique has been successfully used in investigations with low or very low prevalence, including some machine learning techniques such as convolutional neural networks [7].…”

Section: Discussionmentioning

confidence: 99%

Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

Traboulsi

Talibi

Boussaid

2020

Preprint

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Background: Preterm Birth (PTB) can negatively affect the health of mothers as well as infants. Prediction of this gynecological complication remains difficult especially in Middle and Low-Income countries because of limited access to specific tests and data collection scarcity. Multiparous women in our study presented a higher PTB prevalence compared to nulliparous women. Methods: In a cohort study from Northern Lebanon of 1996 women, 922 were multiparous presenting a PTB prevalence of 8%. We analyzed the personal, demographic, and health indicators available for this group of women. We compared 4 modified logistic regression models (up-sampling, lasso penalized regression) to develop a nomogram that can screen for preterm in multi-parous women. The models were trained and validated on different data sets.Results: The best PTB prediction of the Logistic regression model reached around 88%. This was obtained using a Logistic Regression Model trained on up-sampled datasets and LASSO (Least Absolute Shrinkage and Selection Operator) penalized. The regression coefficients of the 6 selected variables (Pre-hemorrhage, Social status, Residence, Age, BMI, and Weight gain) were used to create a nomogram to screen multiparous women for PTB risk. Conclusions: The nomogram based on readily available indicators for multiparous women reasonably predicted most of the at PTB risk women. This tool will allow physicians to screen women that represent a high risk for spontaneous preterm birth and run furthermore adequate additional tests leading to better medical surveillance that can reduce PTB incidence.

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Deep learning predicts extreme preterm birth from electronic health records

Cited by 69 publications

References 48 publications

Comparison of Multivariable Logistic Regression and Other Machine Learning Algorithms for Prognostic Prediction Studies in Pregnancy Care: Systematic Review and Meta-Analysis

Comparison of Multivariable Logistic Regression and Other Machine Learning Algorithms for Prognostic Prediction Studies in Pregnancy Care: Systematic Review and Meta-Analysis

Application of Artificial Intelligence in Early Diagnosis of Spontaneous Preterm Labor and Birth

Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

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