Machine learning for hospital readmission prediction in pediatric population

Abstract

Background and objective: Pediatric readmissions are a burden on patients, families, and the healthcare system. In order to identify patients at higher readmission risk, more accurate techniques, as machine learning (ML), could be a good strategy to expand the knowledge in this area. The aim of this study was to develop predictive models capable of identifying children and adolescents at high risk of potentially avoidable 30-day readmission using ML.

Methods: Retrospective cohort study was carried out with 9,080 patients under 18 years old admitted to a tertiary university hospital. Demographic, clinical, and biochemical data were collected from electronic databases. We randomly divided the dataset into training (75 %) and testing (25 %), applied downsampling, repeated cross-validation with five folds and ten repetitions, and the hyperparameter was optimized of each technique using a grid search via racing with ANOVA models. We applied six ML classification algorithms to build the predictive models, including classification and regression tree (CART), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), decision tree and logistic regression (LR). The area under the receiver operating curve (AUC), sensitivity, specificity, Youden's J-index and accuracy were used to evaluate the performance of each model.

Results: The avoidable 30-day hospital readmissions rate was 9.5 %. Some algorithms presented similar AUC, both in the dataset training and in the dataset testing, such as XGBoost, RF, GBM and CART. Considering the Youden's J-index, the algorithm that presented the best index was XGBoost with bagging imputation, with AUC of 0.814 (J-index of 0.484). Cancer diagnosis, age, red blood cells, leukocytes, red cell distribution width and sodium levels, elective admission, and multimorbidity were the most important characteristics to classify between readmission and non-readmission groups.

Conclusion: Machine learning approaches, especially XGBoost, can predict potentially avoidable 30-day pediatric hospital readmission into tertiary assistance. If implemented in the computer hospital system, our model can help in the early and more accurate identification of patients at readmission risk, targeting health strategic interventions.

Keywords: Clinical decision rules; Hospital readmission; Machine learning; Pediatrics; Risk factors.