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Nanini S, Abid M, Mamouni Y, Wiedemann A, Jouvet P, Bourassa S. Machine and Deep Learning Models for Hypoxemia Severity Triage in CBRNE Emergencies. Diagnostics (Basel) 2024; 14:2763. [PMID: 39682671 DOI: 10.3390/diagnostics14232763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 11/28/2024] [Accepted: 12/01/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study develops machine learning (ML) models to predict hypoxemia severity during emergency triage, particularly in Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) scenarios, using physiological data from medical-grade sensors. METHODS Tree-based models (TBMs) such as XGBoost, LightGBM, CatBoost, Random Forests (RFs), Voting Classifier ensembles, and sequential models (LSTM, GRU) were trained on the MIMIC-III and IV datasets. A preprocessing pipeline addressed missing data, class imbalances, and synthetic data flagged with masks. Models were evaluated using a 5-min prediction window with minute-level interpolations for timely interventions. RESULTS TBMs outperformed sequential models in speed, interpretability, and reliability, making them better suited for real-time decision-making. Feature importance analysis identified six key physiological variables from the enhanced NEWS2+ score and emphasized the value of mask and score features for transparency. Voting Classifier ensembles showed slight metric gains but did not outperform individually optimized models, facing a precision-sensitivity tradeoff and slightly lower F1-scores for key severity levels. CONCLUSIONS TBMs were effective for real-time hypoxemia prediction, while sequential models, though better at temporal handling, were computationally costly. This study highlights ML's potential to improve triage systems and reduce alarm fatigue, with future plans to incorporate multi-hospital datasets for broader applicability.
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Affiliation(s)
- Santino Nanini
- Clinical Decision Support System Articificial Intelligence Health Cluster in Acute Child Care, PE-DIATRICS, CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
- Solutions Applicare AI Inc., Montreal, QC H7L 4W3, Canada
- Faculté des arts et des sciences, Département d'informatique et de recherche opérationnelle (DIRO), Université de Montréal, 3150 Rue Jean-Brillant, Montréal, QC H3T 1N8, Canada
- MEDINT CBRNE Group, 1100 René-Lévesque Blvd W 25 étage, Montréal, QC H3B 5C9, Canada
- Mila-Institut Québécois d'Intelligence Artificielle, 6666 Rue Saint-Urbain, Montréal, QC H2S 3H1, Canada
| | - Mariem Abid
- Clinical Decision Support System Articificial Intelligence Health Cluster in Acute Child Care, PE-DIATRICS, CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
- Solutions Applicare AI Inc., Montreal, QC H7L 4W3, Canada
| | - Yassir Mamouni
- Faculté des arts et des sciences, Département d'informatique et de recherche opérationnelle (DIRO), Université de Montréal, 3150 Rue Jean-Brillant, Montréal, QC H3T 1N8, Canada
- Mila-Institut Québécois d'Intelligence Artificielle, 6666 Rue Saint-Urbain, Montréal, QC H2S 3H1, Canada
| | - Arnaud Wiedemann
- Research Center CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Canada
- Clinical Decision Support System Articificial Intelligence Health Cluster in Acute Child Care, PE-DIATRICS, CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
| | - Philippe Jouvet
- Research Center CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Canada
- Clinical Decision Support System Articificial Intelligence Health Cluster in Acute Child Care, PE-DIATRICS, CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
| | - Stephane Bourassa
- Research Center CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Canada
- Clinical Decision Support System Articificial Intelligence Health Cluster in Acute Child Care, PE-DIATRICS, CHU Ste-Justine Centre Hospitalier Universitaire Mère-Enfant, 3175 Boulevard de la Côte-Sainte-Catherine Drive, Montréal, QC H3T 1C5, Canada
- Department of Mechanical Engineering, École de technologie supérieure (ÉTS), Université du Québec, Montréal, QC G1K 9H7, Canada
- MEDINT CBRNE Group, 1100 René-Lévesque Blvd W 25 étage, Montréal, QC H3B 5C9, Canada
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Hamele M, Poss WB, Sweney J. Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism. World J Crit Care Med 2014; 3:15-23. [PMID: 24834398 PMCID: PMC4021150 DOI: 10.5492/wjccm.v3.i1.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/21/2013] [Accepted: 12/09/2013] [Indexed: 02/06/2023] Open
Abstract
Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11(th), 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.
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Debacker M, Hubloue I, Dhondt E, Rockenschaub G, Rüter A, Codreanu T, Koenig KL, Schultz C, Peleg K, Halpern P, Stratton S, Della Corte F, Delooz H, Ingrassia PL, Colombo D, Castrèn M. Utstein-style template for uniform data reporting of acute medical response in disasters. PLOS CURRENTS 2012; 4:e4f6cf3e8df15a. [PMID: 23066513 PMCID: PMC3461975 DOI: 10.1371/4f6cf3e8df15a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims. METHODS Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique. RESULTS The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement. CONCLUSION It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.
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Affiliation(s)
- Michel Debacker
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Belgium. Academy for Emergency Management and Disaster Medicine (EMDM Academy)
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Bland SA. Chemical, biological and radiation casualties: critical care considerations. J ROY ARMY MED CORPS 2011; 155:160-71. [PMID: 20095187 DOI: 10.1136/jramc-155-02-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A chemical, biological, radiological or nuclear (CBRN) event would require a critical care response from point of exposure to definitive hospital management. Critical care staff should be aware of the potential agents and possible hazard they present to responders. The treatment of CBRN casualties should reflect the conventional incident and casualty management paradigms with additional safety and treatment considerations. Specific agents may require specific airway and respiratory considerations including surrogate ventilation strategies. All critical care staff training should include CBRN awareness and personal protective equipment training. Some staff may benefit from additional training including the recognition and investigation of CBRN casualties as well as their treatment and the equipment available. Critical care departments should also contingency plans for CBRN events including surge capacity.
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Affiliation(s)
- S A Bland
- Emergency Medicine, Queen Alexandra Hospital, Portsmouth.
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Abstract
Acute lung injury can be induced indirectly (e.g., sepsis) or directly (e.g., chlorine inhalation). Because treatment is still limited to supportive measures, mortality remains high ( approximately 74,500 deaths/yr). In the past, accidental (railroad derailments) and intentional (Iraq terrorism) chlorine exposures have led to deaths and hospitalizations from acute lung injury. To better understand the molecular events controlling chlorine-induced acute lung injury, we have developed a functional genomics approach using inbred mice strains. Various mouse strains were exposed to chlorine (45 ppm x 24 h) and survival was monitored. The most divergent strains varied by more than threefold in mean survival time, supporting the likelihood of an underlying genetic basis of susceptibility. These divergent strains are excellent models for additional genetic analysis to identify critical candidate genes controlling chlorine-induced acute lung injury. Gene-targeted mice then could be used to test the functional significance of susceptibility candidate genes, which could be valuable in revealing novel insights into the biology of acute lung injury.
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Abstract
Disasters come in all shapes and forms, and in varying magnitudes and intensities. Nevertheless, they offer many of the same lessons for critical care practitioners and responders. Among these, the most important is that well thought out risk assessment and focused planning are vital. Such assessment and planning require proper training for providers to recognize and treat injury from disaster, while maintaining safety for themselves and others. This article discusses risk assessment and planning in the context of disasters. The article also elaborates on the progress toward the creation of portable, credible, sustainable, and sophisticated critical care outside the walls of an intensive care unit. Finally, the article summarizes yields from military-civilian collaboration in disaster planning and response.
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Affiliation(s)
- Saqib I Dara
- Critical Care Medicine, Al Rahba Hospital-Johns Hopkins International, Abu Dhabi, United Arab Emirates
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Shear TD, Martyn JAJ. Physiology and biology of neuromuscular transmission in health and disease. J Crit Care 2009; 24:5-10. [PMID: 19272533 DOI: 10.1016/j.jcrc.2008.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 08/18/2008] [Indexed: 12/17/2022]
Abstract
The introduction of powerful and contemporary research techniques has allowed for an increasingly detailed understanding of neuromuscular transmission. The classic model of nerve signaling to muscle using acetylcholine has been well described. Newer discovery points toward a more complex signaling system with adaptive receptor physiology and a multifaceted action response scheme for muscle relaxants. Although adding complexity, these newer discoveries help align experimentally derived knowledge with clinical observations. In this review, new concepts relative to neuromuscular transmission in health and disease are discussed, including a detailed discussion of acetylcholine and acetylcholine receptor physiology. Recent elucidations of the pathophysiologic responses to neuromuscular injury and its clinical implications are also detailed.
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Affiliation(s)
- Torin D Shear
- Department of Anesthesia and Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
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Emergency Mass Critical Care. INTENSIVE AND CRITICAL CARE MEDICINE 2009. [PMCID: PMC7122106 DOI: 10.1007/978-88-470-1436-7_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
At any moment regular television programming could be interrupted with news of the emergence of a new strain of infective agent, a major industrial accident, or a terrorist event. Many devastating events are widespread and naturally occurring, like hurricanes, in which we have ample warning time to enact preparation plans; while others, like earthquakes, volcanoes, or tsunamis may kill or injure thousands before the news reports hit the airwaves. Industrial accidents and terrorist events are usually sudden and occur without any warning. Any of these events may have a local or regional effect; some may even have a global impact [1]. Regardless of the cause, after such an event, large amounts of the populace will be seeking medical care, whether from their primary care providers, public health departments, or local hospitals.
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Clinical review: the role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:214. [PMID: 18492221 PMCID: PMC2481436 DOI: 10.1186/cc6876] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care specialists extends well beyond the intensive care unit during such events, and (b) non-intensive care hospital personnel must have the ability to provide basic critical care. The bombing of the London transport network, while highlighting some good practices in our major incident planning, also exposed weaknesses already described by others. Whilst this paper uses the events of the 7 July 2005 as its point of reference, the lessons learned and the changes incorporated in our planning have generic applications to mass casualty events. In the UK, the Department of Health convened an expert symposium in June 2007 to identify lessons learned from 7 July 2005 and disseminate them for the benefit of the wider medical community. The experiences of clinicians from critical care units in London made a large contribution to this process and are discussed in this paper.
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Christian MD, Devereaux AV, Dichter JR, Geiling JA, Rubinson L. Definitive care for the critically ill during a disaster: current capabilities and limitations: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest 2008; 133:8S-17S. [PMID: 18460503 PMCID: PMC7094433 DOI: 10.1378/chest.07-2707] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Accepted: 03/03/2008] [Indexed: 12/27/2022] Open
Abstract
In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care. However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response. This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles. Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions. The deficiency in critical care surge capacity is exacerbated by lack of a sufficient framework to integrate critical care within the overall institutional response and coordination of critical care across local institutions and broader geographic areas.
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Affiliation(s)
- Michael D Christian
- FRCPC, Mount Sinai Hospital, 600 University Ave, Suite 18-206, Toronto, ON, Canada M5G 1X5.
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Scalzo AJ, Lehman-Huskamp KL, Sinks GA, Keenan WJ. Disaster Preparedness and Toxic Exposures in Children. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2008. [DOI: 10.1016/j.cpem.2007.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baker DJ, Telion C, Carli P. Multiple casualty incidents: the prehospital role of the anesthesiologist in Europe. Anesthesiol Clin 2007; 25:179-88, xi. [PMID: 17400164 DOI: 10.1016/j.atc.2006.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The recent increase in incidents involving mass casualties has emphasized the need for a planned and coordinated prehospital emergency medical response, with medical teams on-site to provide advanced trauma life support. The special skills of the anesthesiologist make his/her contribution to prehospital emergency care particularly valuable. The United Kingdom's emergency medical services system is operated paramedically like that in the United States, and is based on rapid evacuation of casualties to hospital emergency medical facilities. In contrast, the French approach is based on the use of its emergency care system SAMU, where both structured dispatching and on-site medical care is provided by physicians, including anesthesiologists. In this article, the lessons learned from multiple casualty incidents in Europe during the past 2 decades are considered from the standpoint of the anesthesiologist.
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Affiliation(s)
- David J Baker
- Department of Anesthesiology and SAMU de Paris, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, 75743 Paris CEDEX 15, France.
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