Abstract

Proactive detection of hemodynamic shock can prevent organ failure and save lives. Thermal imaging is a non-invasive, non-contact modality to capture body surface temperature with the potential to reveal underlying perfusion disturbance in shock. In this study, we automate early detection and prediction of shock using machine learning upon thermal images obtained in a pediatric intensive care unit of a tertiary care hospital. 539 images were recorded out of which 253 had concomitant measurement of continuous intra-arterial blood pressure, the gold standard for shock monitoring. Histogram of oriented gradient features were used for machine learning based region-of-interest segmentation that achieved 96% agreement with a human expert. The segmented center-to-periphery difference along with pulse rate was used in longitudinal prediction of shock at 0, 3, 6 and 12 hours using a generalized linear mixed-effects model. The model achieved a mean area under the receiver operating characteristic curve of 75% at 0 hours (classification), 77% at 3 hours (prediction) and 69% at 12 hours (prediction) respectively. Since hemodynamic shock associated with critical illness and infectious epidemics such as Dengue is often fatal, our model demonstrates an affordable, non-invasive, non-contact and tele-diagnostic decision support system for its reliable detection and prediction.

Highlights

  • Shock is a clinical state of mismatch between the demand and supply of cellular oxygen

  • We report a non-invasive, non-contact modality constructed using a combination of thermal-imaging, machine-learning and longitudinal data analysis for detection and prediction of shock in patients admitted to a pediatric intensive care unit (PICU)

  • This study presents a machine-learning algorithm trained upon thermal images for continuous, non-contact detection and prediction of shock in the PICU

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Summary

Introduction

Shock is a clinical state of mismatch between the demand and supply of cellular oxygen. Shock affects almost 30% of ICU patients[1] with mortality rates as high as 34% especially in the developing countries[2]. Hemodynamic compromise is prevalent in the ICUs and in the community in developing countries with low doctor-to-patient ratio and high rate of infections such as dengue and diarrhea that often lead to shock. A non-invasive, non-contact modality for monitoring hemodynamic status is highly desirable for guiding shock management. We report a non-invasive, non-contact modality constructed using a combination of thermal-imaging, machine-learning and longitudinal data analysis for detection and prediction of shock in patients admitted to a pediatric intensive care unit (PICU). The aim of this study was to construct a robust, non-invasive, non-contact, automated and affordable pipeline for shock prediction using machine learning and this is demonstrated through superior model prediction indices. The potential to scale beyond the intensive care settings to emergency rooms and the community make this study especially valuable for decision making for shock in resource-limited settings

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