Multimodal EHR-Based Prediction of Pediatric Asthma Exacerbations.

Pediatric asthma exacerbations are a frequent cause of emergency department (ED) visits and hospitalizations, yet accurate risk prediction remains limited and no consensus risk scores exist. Using UF Health electronic health records (EHRs) from 2011-2023, we evaluated two computable phenotypes (i.e., CAPriCORN and COMPAC) to predict exacerbations over 6-, 12-, and 24-month horizons. Exacerbations were defined using a validated composite of diagnosis codes from ED, inpatient, or outpatient encounters combined with systemic corticosteroids prescriptions. Several commonly used machine learning (ML) models were trained with stratified five-fold cross-validation, Bayesian hyper-parameter optimization, and Youden's J thresholding. XGBoost achieved the best performance, with SHapley Additive exPlanations (SHAP) highlighting note-derived symptom terms and rescue-medication use as dominant predictors. Future work will focus on external validation and assessment of generalizability. This interpretable, text-integrated framework may support child-specific risk stratification and inform EHR-based decision support for timely pediatric asthma management.