Pattern Mining for Critical Care

Shameek Ghosh
Shameek.Ghosh@student.uts.edu.au
Supervised By
Associate Prof. Jinyan Li

Outline

Healthcare Analytics
Details of the MIMIC II Database
Some basic statistics
The Research Problem

Healthcare Analytics
Mining of Raw EHR can help develop a
clinical model of the patients history
Aids in the diagnostic process by the
hospital and physician
Complex healthcare systems generating
massive data

Dearth of tools that can quantitatively

support fast analysis of complex, highfrequency unstructured medical data
streams

MIMIC II Research Database

PHYSIONET
MIMIC II CLINICAL
DATABASE
Patient Demographics
Medications
Lab Results
Nursing Notes

MIMIC II WAVEFORM
DATABASE
ECG
Blood Pressure
Heart Rate
Vital Physiological Signals

Describing an ICU patient

Any patient (unique patient id?) who was admitted to the ICU
on more than one occasion ( multiple icu stay ids in the same
visit?) may be represented by multiple patient visits (unique
hospital admission ids?)
The adult ICUs (for patients aged 15 years and over) include
medical (MICU), surgical (SICU), coronary (CCU), and cardiac
surgery (CSRU) care units (unique care unit ids?)
For neonates, the neonatal ICU (NICU) data was also collected
Note: Patient may have been admitted several times during the 10
year period in which MIMIC data was collected

How to identify a patient?

Case_ID
Will have a set of

Waveforms

Hadm_ID

Subject_ID
Can have
many

Can have
many

Can have many

icu_stay_ID

Patient timeline

Tables of Importance
The basic information for any given patient is stored in the
table D_PATIENTS
Subject_ID is widely used by throughout MIMIC II to specify to
which patient a given measurement or recording refers to
D_PATIENTS is associated by the subject_id to ICD9 ( codes for
r International Classification of Diseases) and DRGEVENTS (
patient specific diagnosis events)
The ICD-9 table records the ICD-9 codes applied to a particular
patient during a specific hospitalization period.
Diagnosis-related groups (DRGs) are stored in the DRGEVENTS
table and their meanings are stored in D_CODEDITEMS.

Tables of Importance
Caregivers are stored in the D_CAREGIVER table (cgid). Caregivers related
to many other tables such as medevents, noteevents and chartevents and
is used to record the care giver who performed a particular operation,
procedure or event
The Careunits table D_CAREUNITS (cuid), stores information pertaining to
the different ICU rooms in the hospital and whenever a problem occurs or
a chart event is entered, the particular care unit is also recorded
Medication(s) given to a patient are recorded in the medevents,
d_meditems, a_meddurations and additives tables
Patient medical chart data is recorded in the chartevents, d_chartitems,
a_chartdurations and formevents tables
Patient input/output (IO) data is recorded in the ioevents, d_ioitems,
a_iodurations, deliveries, totalbalevents and additives tables
Patient notes are recorded in the noteevents table

Some Basic Statistics from MIMIC

Total number MIMIC specific relations: 38

Total No. of patients: 32535
Patients with Cardiac Arrests: 640
Patients with Acute Kidney Injury: 3396

Blood Pressure Prediction

Waldin, A et al (2013). In the proceedings of the 30th International Conference on Machine Learning. JMLR
W&CP volume 28.

Importance of BP prediction in ICU

BP is related to hypotension
Hypotension is related to Acute Kidney Injury (AKI)
AKI can arise in an ICU for cardiopulmonary bypass, major trauma, mechanical
ventilation, burn injuries, sepsis and in many other diseases
AKI results in mortality (loss of life) and morbidity (increased hospital stay causing
chronic conditions)
Need to investigate hemodynamic (blood flow) perturbations to understand the
incidence of AKI
Discriminative sequential patterns could be explored in arterial blood pressure
that might help in predicting stages of AKI
Predicting Acute Hypotensive Episodes (Physionet Challenge 2009)
Predicting an ICU patient's future blood pressure from a recording of his recent
blood pressure history (Waldin, 2013)

Dennen, P., et al. (2010). Critical care medicine, 38(1), 261-275.

Lehman, L. W., et al (2010). Computing in Cardiology, pp. 1095-1098). IEEE.

Acute Hypotensive Episodes (AHE)

An acute hypotensive episode requires effective and prompt

intervention in an ICU
41% experienced recorded episodes of acute hypotension
during their ICU stays
AHE - any period of 30 minutes or more when 90% of MAP
readings were at or below 60mmHg
If one might forecast acute hypotensive episodes in the ICU,
there is a possibility of improving care and survival of patients
at risk of these events

Problem Description
Given a continuos mean arterial signal from time - 1t, our
goal is to predict the value of a statistic defined for the sample
over a time period (t+k) to (t+k+a), where k is the lead time
and a is the prediction window
Additional issues that can be handled by algorithm: 1)
Prediction window size 2) Definition of prediction statistic (as
reported by Waldin, 2013)

Conclusion

Determination of interesting sequences of events indicative of future critical

conditions in ICU patients is important

Can help in understanding variations in physiological patterns

Clustering treatment plans based on similar patterns in ICU patients

In the mining of abnormal events

Evolving set of events provides an excellent interpretive patient knowledge to a

physician