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A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis

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Author(s)
Chang Sik SonByoung Kuk JangSuk Tae SeoMin Soo KimYoon Nyun Kim
Keimyung Author(s)
Jang, Byoung KukKim, Yoon Nyun
Department
Dept. of Internal Medicine (내과학)
Journal Title
BMC Medical Informatics and Decision Making
Issued Date
2012
Volume
12
Issue
1
Abstract
BACKGROUND:
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.
Keimyung Author(s)(Kor)
장병국
김윤년
Publisher
School of Medicine
Citation
Chang Sik Son et al. (2012). A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis. BMC Medical Informatics and Decision Making, 12(1), 17–17. doi: 10.1186%2F1472-6947-12-17
Type
Article
ISSN
1472-6947
DOI
10.1186%2F1472-6947-12-17
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/35243
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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