Online pattern recognition based on a generalized hidden Markov model for intraoperative vital sign monitoring

Abstract

AbstractThe trend patterns of vital signs provide significant insight into the interpretation of intraoperative physiological measurements. We have modeled the trend signal of a vital sign parameter as a generalized hidden Markov model (also known as a hidden semi‐Markov model). This model treats a time series as a sequence of predefined patterns and describes the transition between these patterns as a first‐order Markov process and the intra‐segmental variations as different dynamic linear systems. Based on this model, a switching Kalman smoother combines a Bayesian inference process with a fixed‐point Kalman smoother in order to estimate the unconditional true signal values and generates the probability of occurrence for each pattern online. The probabilities of pattern transitions are tested against a threshold to detect change points. A second‐order generalized pseudo‐Bayesian algorithm is used to summarize the state propagation over time and reduces the computational overhead. The memory complexity is reduced using linked tables. The algorithm was tested on 30 simulated signals and 10 non‐invasive‐mean‐blood‐pressure trend signals collected at a local hospital. In the simulated test, the algorithm achieved a high accuracy of signal estimation and pattern recognition. In the test on clinical data, the change directions of 45 trend segments, out of the 54 segments annotated by an expert, were correctly detected with the best performing threshold, and with the introduction of only 8 false‐positive detections. The proposed method can detect the changes of trend patterns in a time series online, while generating quantitative evaluation of the significance of detection. This method is promising for physiological monitoring as the method not only generates early alerts, but also summarizes the temporal contextual information for a high‐level decision support system. Copyright © 2009 John Wiley & Sons, Ltd.