A subgroup discovery approach for scrutinizing blood glucose management guidelines by the identification of hyperglycemia determinants in ICU patients.
OBJECTIVE
Despite the wide use of blood glucose management guidelines in intensive care (IC), hyperglycemia is still common. The aim of this study was the discovery of possible hyperglycemia determinants by applying the Patient Rule Induction Method (PRIM) to routinely collected data within the first 24 hours of admission, and to relate them to the literature.


METHODS
PRIM was applied in two set-ups to data of 2001 IC patients including 50,021 records of blood glucose levels and other variables. The independent predictors of blood glucose measurements were variables whose value is known before the time of the corresponding measurement. Subgroups were validated using a random split design, and time-sensitivity of performance was analyzed.


RESULTS
PRIM was able to identify relatively large subgroups having markedly high mean glucose values. PRIM also discovered possible determinants of which less is known about their relationship to hyperglycemia. Some possible determinants reported in the literature were not found by PRIM.


CONCLUSIONS
We demonstrated for the first time the utility of using subgroup discovery to uncover possible determinants for non-responsiveness to treatment. This implies the possible use of this technology to scrutinize the effects of various guidelines in clinical medicine on patient outcomes without requiring the development of a global predictive model. We hypothesize that by focusing on the identified subgroups, clinical guidelines may be improved. Further research is required to test this hypothesis.
Nannings
B
B
Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Bosman
R-J
RJ
Abu-Hanna
A
A
D001786:Blood Glucose; D016638:Critical Illness; D016903:Drug Monitoring; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007256:Information Systems; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin