Clinical trial NCT04005001: Machine Learning Sepsis Alert Notification Using Clinical Data
Official title: Using Clinical Treatment Data in a Machine Learning Approach for Sepsis Detection
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE2
Conditions: Sepsis
Severe Sepsis
Septic Shock
Keywords: Sepsis
Machine learning algorithm
Clinical decision support
Lead sponsor: Dascena
Sponsor class: INDUSTRY
Collaborators: name: Cape Regional Medical Center
name: Cooper University Medical Center
name: Baystate Health
name: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
First posted: 2019-07-02
Enrollment: 37986
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: Machine learning is a powerful method to create clinical decision support (CDS) tools, when training labels reflect the desired alert behavior. In our Phase I work for this project, we developed HindSight, an encoding software that was designed to examine discharged patients' electronic health records (EHRs), identify clinicians' sepsis treatment decisions and patient outcomes, and pass those labeled outcomes and treatment decisions to an online algorithm for retraining of our machine-learning-based CDS tool for real-time sepsis alert notification, InSight. HindSight improved the performance of InSight sepsis alerts in retrospective work. In this study, we propose to assess the clinical utility of HindSight by conducting a multicenter prospective randomized controlled trial (RCT) for more accurate sepsis alerts.

Detailed description: We will evaluate the performance of HindSight in a randomized controlled trial (RCT). HindSight is a novel encoding software designed to optimize alerts for sepsis alert notification. HindSight identifies clinicians' sepsis-related decisions in the electronic health records of former patients and passes those events to InSight, thus supplying InSight with labeled examples of true positive sepsis cases for retraining. In our retrospective work, we have shown that HindSight enables InSight to adapt to site-specific deviations of real-world clinical deployment by successfully reducing false and irrelevant alarms, without human supervision. The goal of this project is to demonstrate that the retrospective success of HindSight can be successfully translated to live clinical environments. In our Phase I work, HindSight achieved an area under the receiver-operating characteristic (AUROC) of 0.899, 0.831 and 0.877 for clinician sepsis evaluation, treatment, and onset, respectively. By using an online learning algorithm to incorporate HindSight-labeled data into the InSight predictor, we showed that the online-trained InSight can adapt to the HindSight-labeled data and outperform both baseline and periodically re-trained versions of InSight (p \< 0.05). In Aim 1, we will prospectively validate HindSight's performance on real-time patient data streams in three diverse hospitals non-interventionally. In Aim 2, we will evaluate the effect of the tool in a prospective, interventional RCT. HindSight will first be evaluated by live deployment at four academic and community hospitals, during which time it will not provide alerts of future sepsis onset. Following any necessary algorithm optimization arising from live hospital validation, we will perform an RCT to evaluate reductions in false alerts from InSight trained on HindSight sepsis labels (experimental arm), compared to InSight trained on gold standard Sepsis-3 labels (control arm).

Eligibility criteria: Inclusion Criteria:

* During the study period, all patients over the age of 18 presenting to the emergency department or admitted to an inpatient unit at the participating facilities will automatically be enrolled in the study, until the enrollment target for the study is met

Exclusion Criteria:

* Patients under the age of 18
* Prisoners

Primary outcomes:
measure: Rate of reduction in false alerts
timeFrame: Through study completion, human subjects involvement will occur for an average of eight months
Secondary outcomes:
Other outcomes:
Locations:
city: Springfield
country: United States
facility: Baystate Health
state: Massachusetts
city: Camden
country: United States
facility: Cooper University Health Care
state: New Jersey
city: Cape May
country: United States
facility: Cape Regional Medical Center
state: New Jersey
Study officials:
affiliation: Dascena
name: Jana Hoffman, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Desautels T, Calvert J, Hoffman J, Mao Q, Jay M, Fletcher G, Barton C, Chettipally U, Kerem Y, Das R. Using Transfer Learning for Improved Mortality Prediction in a Data-Scarce Hospital Setting. Biomed Inform Insights. 2017 Jun 12;9:1178222617712994. doi: 10.1177/1178222617712994. eCollection 2017.
citation: Calvert J, Mao Q, Rogers AJ, Barton C, Jay M, Desautels T, Mohamadlou H, Jan J, Das R. A computational approach to mortality prediction of alcohol use disorder inpatients. Comput Biol Med. 2016 Aug 1;75:74-9. doi: 10.1016/j.compbiomed.2016.05.015. Epub 2016 May 24.
citation: Calvert JS, Price DA, Barton CW, Chettipally UK, Das R. Discharge recommendation based on a novel technique of homeostatic analysis. J Am Med Inform Assoc. 2017 Jan;24(1):24-29. doi: 10.1093/jamia/ocw014. Epub 2016 Mar 28.
citation: Calvert J, Mao Q, Hoffman JL, Jay M, Desautels T, Mohamadlou H, Chettipally U, Das R. Using electronic health record collected clinical variables to predict medical intensive care unit mortality. Ann Med Surg (Lond). 2016 Sep 6;11:52-57. doi: 10.1016/j.amsu.2016.09.002. eCollection 2016 Nov.
citation: Shimabukuro DW, Barton CW, Feldman MD, Mataraso SJ, Das R. Effect of a machine learning-based severe sepsis prediction algorithm on patient survival and hospital length of stay: a randomised clinical trial. BMJ Open Respir Res. 2017 Nov 9;4(1):e000234. doi: 10.1136/bmjresp-2017-000234. eCollection 2017.