TY  - JOUR
AU  - de Koning, Enrico
AU  - van der Haas, Yvette
AU  - Saguna, Saguna
AU  - Stoop, Esmee
AU  - Bosch, Jan
AU  - Beeres, Saskia
AU  - Schalij, Martin
AU  - Boogers, Mark
PY  - 2023
DA  - 2023/10/31
TI  - AI Algorithm to Predict Acute Coronary Syndrome in Prehospital Cardiac Care: Retrospective Cohort Study
JO  - JMIR Cardio
SP  - e51375
VL  - 7
KW  - cardiology
KW  - acute coronary syndrome
KW  - Hollands Midden Acute Regional Triage–cardiology
KW  - prehospital
KW  - triage
KW  - artificial intelligence
KW  - natural language processing
KW  - angina
KW  - algorithm
KW  - overcrowding
KW  - emergency department
KW  - clinical decision-making
KW  - emergency medical service
KW  - paramedics
AB  - Background: Overcrowding of hospitals and emergency departments (EDs) is a growing problem. However, not all ED consultations are necessary. For example, 80% of patients in the ED with chest pain do not have an acute coronary syndrome (ACS). Artificial intelligence (AI) is useful in analyzing (medical) data, and might aid health care workers in prehospital clinical decision-making before patients are presented to the hospital. Objective: The aim of this study was to develop an AI model which would be able to predict ACS before patients visit the ED. The model retrospectively analyzed prehospital data acquired by emergency medical services' nurse paramedics. Methods: Patients presenting to the emergency medical services with symptoms suggestive of ACS between September 2018 and September 2020 were included. An AI model using a supervised text classification algorithm was developed to analyze data. Data were analyzed for all 7458 patients (mean 68, SD 15 years, 54% men). Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for control and intervention groups. At first, a machine learning (ML) algorithm (or model) was chosen; afterward, the features needed were selected and then the model was tested and improved using iterative evaluation and in a further step through hyperparameter tuning. Finally, a method was selected to explain the final AI model. Results: The AI model had a specificity of 11% and a sensitivity of 99.5% whereas usual care had a specificity of 1% and a sensitivity of 99.5%. The PPV of the AI model was 15% and the NPV was 99%. The PPV of usual care was 13% and the NPV was 94%. Conclusions: The AI model was able to predict ACS based on retrospective data from the prehospital setting. It led to an increase in specificity (from 1% to 11%) and NPV (from 94% to 99%) when compared to usual care, with a similar sensitivity. Due to the retrospective nature of this study and the singular focus on ACS it should be seen as a proof-of-concept. Other (possibly life-threatening) diagnoses were not analyzed. Future prospective validation is necessary before implementation. 
SN  - 2561-1011
UR  - https://cardio.jmir.org/2023/1/e51375
UR  - https://doi.org/10.2196/51375
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37906226
DO  - 10.2196/51375
ID  - info:doi/10.2196/51375
ER  -