title: Application of artificial neural networks to establish a predictive mortality risk model in children admitted to a paediatric intensive care unit.
abstract: BACKGROUND
  Paediatric risk of mortality and paediatric index of mortality (PIM) are the commonly-used mortality prediction models (MPM) in children admitted to paediatric intensive care unit (PICU). The current study was undertaken to develop a better MPM using artificial neural network, a domain of artificial intelligence.
  
  
  METHODS
  The purpose of this retrospective case series was to compare an artificial neural network (ANN) model and PIM with the observed mortality in a cohort of patients admitted to a five-bed PICU in a Hong Kong non-teaching general hospital. The patients were under the age of 17 years and admitted to our PICU from April 2001 to December 2004. Data were collected from each patient admitted to our PICU. All data were randomly allocated to either the training or validation set. The data from the training set were used to construct a series of ANN models. The data from the validation set were used to validate the ANN and PIM models. The accuracy of ANN models and PIM was assessed by area under the receiver operator characteristics (ROC) curve and calibration.
  
  
  RESULTS
  All data were randomly allocated to either the training (n=274) or validation set (n=273). Three ANN models were developed using the data from the training set, namely ANN8 (trained with variables required for PIM), ANN9 (trained with variables required for PIM and pre-ICU intubation) and ANN23 (trained with variables required for ANN9 and 14 principal ICU diagnoses). Three ANN models and PIM were used to predict mortality in the validation set. We found that PIM and ANN9 had a high ROC curve (PIM: 0.808, 95 percent confidence interval 0.552 to 1.000, ANN9: 0.957, 95 percent confidence interval 0.915 to 1.000), whereas ANN8 and ANN23 gave a suboptimal area under the ROC curve. ANN8 required only five variables for the calculation of risk, compared with eight for PIM.
  
  
  CONCLUSIONS
  The current study demonstrated the process of predictive mortality risk model development using ANN. Further multicentre studies are required to produce a representative ANN-based mortality prediction model for use in different PICUs.
authors.affiliation: Department of Paediatrics, Kwong Wah Hospital, Waterloo Road, Hong Kong SAR, China.
authors.forename: C H
authors.initials: CH
authors.lastname: Chan
authors.forename: E Y
authors.initials: EY
authors.lastname: Chan
authors.forename: D K
authors.initials: DK
authors.lastname: Ng
authors.forename: P Y
authors.initials: PY
authors.lastname: Chow
authors.forename: K L
authors.initials: KL
authors.lastname: Kwok
mesh_terms: D000293:Adolescent; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D016571:Neural Networks, Computer; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies