Covid-19 triage in the emergency department 2.0: how analytics and AI transform a human-made algorithm for the prediction of clinical pathways

Christina C. Bartenschlager, Milena Grieger, Johanna Erber, Tobias Neidel, Stefan Borgmann, Jörg J. Vehreschild, Markus Steinbrecher, Siegbert Rieg, Melanie Stecher, Christine Dhillon, Maria M. Ruethrich, Carolin E. M. Jakob, Martin Hower, Axel R. Heller, Maria Vehreschild, Christoph Wyen, Helmut Messmann, Christiane Piepel, Jens O. Brunner (), Frank Hanses and Christoph Römmele
Additional contact information
Christina C. Bartenschlager: University of Augsburg
Milena Grieger: University of Augsburg
Johanna Erber: Technical University of Munich, School of Medicine, University Hospital Rechts Der Isar
Tobias Neidel: University of Augsburg
Stefan Borgmann: Klinikum Ingolstadt
Jörg J. Vehreschild: Goethe University Frankfurt
Markus Steinbrecher: University Hospital Augsburg
Siegbert Rieg: University Hospital Freiburg
Melanie Stecher: University of Cologne, University Hospital of Cologne
Christine Dhillon: University Hospital Augsburg
Maria M. Ruethrich: University Hospital Jena
Carolin E. M. Jakob: University of Cologne, University Hospital of Cologne
Martin Hower: Pneumology, Infectiology and Internal Intensive Care Medicine
Axel R. Heller: University of Augsburg
Maria Vehreschild: University Hospital Frankfurt, Goethe University Frankfurt
Christoph Wyen: Praxis am Ebertplatz
Helmut Messmann: University Hospital Augsburg
Christiane Piepel: Klinikum Bremen-Mitte
Jens O. Brunner: University of Augsburg
Frank Hanses: University Hospital Regensburg
Christoph Römmele: University Hospital Augsburg

Health Care Management Science, 2023, vol. 26, issue 3, No 2, 412-429

Abstract: Abstract The Covid-19 pandemic has pushed many hospitals to their capacity limits. Therefore, a triage of patients has been discussed controversially primarily through an ethical perspective. The term triage contains many aspects such as urgency of treatment, severity of the disease and pre-existing conditions, access to critical care, or the classification of patients regarding subsequent clinical pathways starting from the emergency department. The determination of the pathways is important not only for patient care, but also for capacity planning in hospitals. We examine the performance of a human-made triage algorithm for clinical pathways which is considered a guideline for emergency departments in Germany based on a large multicenter dataset with over 4,000 European Covid-19 patients from the LEOSS registry. We find an accuracy of 28 percent and approximately 15 percent sensitivity for the ward class. The results serve as a benchmark for our extensions including an additional category of palliative care as a new label, analytics, AI, XAI, and interactive techniques. We find significant potential of analytics and AI in Covid-19 triage regarding accuracy, sensitivity, and other performance metrics whilst our interactive human-AI algorithm shows superior performance with approximately 73 percent accuracy and up to 76 percent sensitivity. The results are independent of the data preparation process regarding the imputation of missing values or grouping of comorbidities. In addition, we find that the consideration of an additional label palliative care does not improve the results.

Keywords: Covid-19 triage; Clinical decision making; Predictive analytics; Artificial intelligence; Machine learning (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10729-023-09647-2

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