BMC Med Inform Decis Mak - A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis.


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CKGROUND: The aim of this study is to develop a simple and reliable hybrid decision support model by combining statistical analysis and decision tree algorithms to ensure high accuracy of early diagnosis in patients with suspected acute appendicitis and to identify useful decision rules.METHODS: We enrolled 326 patients who attended an emergency medical center complaining mainly of acute abdominal pain. Statistical analysis approaches were used as a feature selection process in the design of decision support models, including the Chi-square test, Fisher's exact test, the Mann-Whitney U-test (p < 0.01), and Wald forward logistic regression (entry and removal criteria of 0.01 and 0.05, or 0.05 and 0.10, respectively). The final decision support models were constructed using the C5.0 decision tree algorithm of Clementine 12.0 after pre-processing.RESULTS: Of 55 variables, two subsets were found to be indispensable for early diagnostic knowledge discovery in acute appendicitis. The two subsets were as follows: (1) lymphocytes, urine glucose, total bilirubin, total amylase, chloride, red blood cell, neutrophils, eosinophils, white blood cell, complaints, basophils, glucose, monocytes, activated partial thromboplastin time, urine ketone, and direct bilirubin in the univariate analysis-based model; and (2) neutrophils, complaints, total bilirubin, urine glucose, and lipase in the multivariate analysis-based model. The experimental results showed that the model with univariate analysis (80.2%, 82.4%, 78.3%, 76.8%, 83.5%, and 80.3%) outperformed models using multivariate analysis (71.6%, 69.3%, 73.7%, 69.7%, 73.3%, and 71.5% with entry and removal criteria of 0.01 and 0.05; 73.5%, 66.0%, 80.0%, 74.3%, 72.9%, and 73.0% with entry and removal criteria of 0.05 and 0.10) in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under ROC curve, during a 10-fold cross validation. A statistically significant difference was detected in the pairwise comparison of ROC curves (p < 0.01, 95% CI, 3.13-14.5; p < 0.05, 95% CI, 1.54-13.1). The larger induced decision model was more effective for identifying acute appendicitis in patients with acute abdominal pain, whereas the smaller induced decision tree was less accurate with the test data.CONCLUSIONS: The decision model developed in this study can be applied as an aid in the initial decision making of clinicians to increase vigilance in cases of suspected acute appendicitis.

Resumo Limpo

ckground aim studi develop simpl reliabl hybrid decis support model combin statist analysi decis tree algorithm ensur high accuraci earli diagnosi patient suspect acut append identifi use decis rulesmethod enrol patient attend emerg medic center complain main acut abdomin pain statist analysi approach use featur select process design decis support model includ chisquar test fisher exact test mannwhitney utest p wald forward logist regress entri remov criteria respect final decis support model construct use c decis tree algorithm clementin preprocessingresult variabl two subset found indispens earli diagnost knowledg discoveri acut append two subset follow lymphocyt urin glucos total bilirubin total amylas chlorid red blood cell neutrophil eosinophil white blood cell complaint basophil glucos monocyt activ partial thromboplastin time urin keton direct bilirubin univari analysisbas model neutrophil complaint total bilirubin urin glucos lipas multivari analysisbas model experiment result show model univari analysi outperform model use multivari analysi entri remov criteria entri remov criteria term accuraci sensit specif posit predict valu negat predict valu area roc curv fold cross valid statist signific differ detect pairwis comparison roc curv p ci p ci larger induc decis model effect identifi acut append patient acut abdomin pain wherea smaller induc decis tree less accur test dataconclus decis model develop studi can appli aid initi decis make clinician increas vigil case suspect acut append

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