Citation
Goodman, Katherine E.; Lessler, Justin; Harris, Anthony D.; Milstone, Aaron M.; & Tamma, Pranita D. (2019). A Methodological Comparison of Risk Scores versus Decision Trees for Predicting Drug-Resistant Infections: A Case Study Using Extended-Spectrum Beta-Lactamase (ESBL) Bacteremia. Infection Control and Hospital Epidemiology, 40(4), 400-407.Abstract
BACKGROUND: Timely identification of multidrug-resistant gram-negative infections remains an epidemiological challenge. Statistical models for predicting drug resistance can offer utility where rapid diagnostics are unavailable or resource-impractical. Logistic regression-derived risk scores are common in the healthcare epidemiology literature. Machine learning-derived decision trees are an alternative approach for developing decision support tools. Our group previously reported on a decision tree for predicting ESBL bloodstream infections. Our objective in the current study was to develop a risk score from the same ESBL dataset to compare these 2 methods and to offer general guiding principles for using each approach.METHODS: Using a dataset of 1,288 patients with Escherichia coli or Klebsiella spp bacteremia, we generated a risk score to predict the likelihood that a bacteremic patient was infected with an ESBL-producer. We evaluated discrimination (original and cross-validated models) using receiver operating characteristic curves and C statistics. We compared risk score and decision tree performance, and we reviewed their practical and methodological attributes.
RESULTS: In total, 194 patients (15%) were infected with ESBL-producing bacteremia. The clinical risk score included 14 variables, compared to the 5 decision-tree variables. The positive and negative predictive values of the risk score and decision tree were similar (>90%), but the C statistic of the risk score (0.87) was 10% higher.
CONCLUSIONS: A decision tree and risk score performed similarly for predicting ESBL infection. The decision tree was more user-friendly, with fewer variables for the end user, whereas the risk score offered higher discrimination and greater flexibility for adjusting sensitivity and specificity.
URL
http://dx.doi.org/10.1017/ice.2019.17Reference Type
Journal ArticleYear Published
2019Journal Title
Infection Control and Hospital EpidemiologyAuthor(s)
Goodman, Katherine E.Lessler, Justin
Harris, Anthony D.
Milstone, Aaron M.
Tamma, Pranita D.