ArticleJMIR medical informatics2021
Optimal Triage for COVID-19 Patients Under Limited Health Care Resources With a Parsimonious Machine Learning Prediction Model and Threshold Optimization Using Discrete-Event Simulation: Development Study.
Article in JMIR medical informatics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Optimal resource allocation model for COVID-19: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Review
- Hybrid modelling using simulation and machine learning in healthcare.Computers & operations research · 2026Review
- Combined Applications of Artificial Intelligence and Simulation for Healthcare Process Optimization: A Systematic Review.Healthcare (Basel, Switzerland) · 2025Review
- Mapping and Summarizing the Research on AI Systems for Automating Medical History Taking and Triage: Scoping Review.Journal of medical Internet research · 2025Article
- Investigating Ethical Tradeoffs in Crisis Standards of Care through Simulation of Ventilator Allocation Protocols.medRxiv : the preprint server for health sciences · 2024Article
- Development and Validation of a Robust and Interpretable Early Triaging Support System for Patients Hospitalized With COVID-19: Predictive Algorithm Modeling and Interpretation Study.Journal of medical Internet research · 2024Article
- Investigating ethical tradeoffs in crisis standards of care through simulation of ventilator allocation protocols.PloS one · 2024Article
- Artificial intelligence and discrete-event simulation for capacity management of intensive care units during the Covid-19 pandemic: A case study.Journal of business research · 2023Article
- Integration of Machine Learning Algorithms and Discrete-Event Simulation for the Cost of Healthcare Resources.Healthcare (Basel, Switzerland) · 2022Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe COVID-19 pandemic has placed an unprecedented burden on health care systems.
objectiveWe aimed to effectively triage COVID-19 patients within situations of limited data availability and explore optimal thresholds to minimize mortality rates while maintaining health care system capacity.
methodsA nationwide sample of 5601 patients confirmed with COVID-19 until April 2020 was retrospectively reviewed. Extreme gradient boosting (XGBoost) and logistic regression analysis were used to develop prediction models for the maximum clinical severity during hospitalization, classified according to the World Health Organization Ordinal Scale for Clinical Improvement (OSCI). The recursive feature elimination technique was used to evaluate the maintenance of model performance when clinical and laboratory variables were eliminated. Using populations based on hypothetical patient influx scenarios, discrete-event simulation was performed to find an optimal threshold within limited resource environments that minimizes mortality rates.
resultsThe cross-validated area under the receiver operating characteristic curve (AUROC) of the baseline XGBoost model that utilized all 37 variables was 0.965 for OSCI ≥6. Compared to the baseline model's performance, the AUROC of the feature-eliminated model that utilized 17 variables was maintained at 0.963 with statistical insignificance. Optimal thresholds were found to minimize mortality rates in a hypothetical patient influx scenario. The benefit of utilizing an optimal triage threshold was clear, reducing mortality up to 18.1%, compared with the conventional Youden index.
conclusionsOur adaptive triage model and its threshold optimization capability revealed that COVID-19 management can be achieved via the cooperation of both the medical and health care management sectors for maximum treatment efficacy. The model is available online for clinical implementation.
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