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- Septic shock diagnosis by neural networks and rule based systems (2002)
- In intensive care units physicians are aware of a high lethality rate of septic shock patients. In this contribution we present typical problems and results of a retrospective, data driven analysis based on two neural network methods applied on the data of two clinical studies. Our approach includes necessary steps of data mining, i.e. building up a data base, cleaning and preprocessing the data and finally choosing an adequate analysis for the medical patient data. We chose two architectures based on supervised neural networks. The patient data is classified into two classes (survived and deceased) by a diagnosis based either on the black-box approach of a growing RBF network and otherwise on a second network which can be used to explain its diagnosis by human-understandable diagnostic rules. The advantages and drawbacks of these classification methods for an early warning system are discussed.
- Neuronal networks for sepsis prediction - the MEDAN project (2004)
- Since the description of sepsis by Schottmüller in 1914, the amount on knowledge available on sepsis and its underlying pathophysiology has substantially increased. Epidemiologic examinations of abdominal septic shock patients show the potential for high risk posed by and the extensive therapy situation in the intensive care unit (ICU) (5). Unfortunately, until now it has not been possible to significantly reduce the mortality rate of septic shock, which is as high as 50-60% worldwide, although PROWESS' results (1) are encouraging. This paper summarizes the main results of the MEDAN project and their medical impacts. Several aspects are already published, see the references. The heterogeneity of patient groups and the variations in therapy strategies is seen as one of the main problems for sepsis trials. In the MEDAN multi-center study of 71 intensive care units in Germany, a group of 382 patients made up exclusively of abdominal septic shock patients who met the consensus criteria for septic shock (3) was analysed. For use within scores or stand-alone experiments variables are often studied as isolated variables, not as a multidimensional whole, e.g. a recent study takes a look at the role thrombocytes play (15). To avoid this limitation, our study compares several established scores (SOFA, APACHE II, SAPS II, MODS) by a multi-dimensional neuronal network analysis. For outcome prediction the data of 382 patients was analysed by using most of the commonly documented vital parameters and doses of medicine (metric variables). Data was collected in German hospitals from 1998 to 2001. The 382 handwritten patient records were transferred to an electronic database giving the amount of 2.5 million data entries. The metric data contained in the database is composed of daily measurements and doses of medicine. We used range and plausibility checks to allow no faulty data in the electronic database. 187 of the 382 patients are deceased (49 %).