risk factor | The Journal of Critical Care Medicine

Development of a Machine Learning-Based Model for Predicting the Incidence of Peripheral Intravenous Catheter-Associated Phlebitis

Hideto Yasuda^1,2,3,4, Claire M. Rickard3,^{4, 5}, Olivier Mimoz^6,7,8, Nicole Marsh^3,4,5, Jessica A Schults^3,4,5, Bertrand Drugeon^6,7, Masahiro Kashiura¹, Yuki Kishihara¹, Yutaro Shinzato¹, Midori Koike¹, Takashi Moriya¹, Yuki Kotani⁹, Natsuki Kondo¹⁰, Kosuke Sekine¹¹, Nobuaki Shime¹², Keita Morikane¹³, Takayuki Abe^14,15

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, Saitama, Japan
2 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan
3 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
4 School of Nursing and Midwifery; Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia
5 Herston Infectious Diseases Institute; Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Metro North Health, Herston, QLD, Australia
6 CHU de Poitiers, Emergency Department and prehospital care, Poitiers, France
7 University of Poitiers, INSERM U1070, Pharmacology of antimicrobial agents and antibiotics resistance (PHAR2), Poitiers, France
8 University of Poitiers, Faculty of Medicine and Pharmacy, Poitiers, France
9 Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
10 Department of Emergency Medicine, Koga Community Hospital, Shizuoka, Japan
11 Department of Medical Engineer, Kameda Medical Center, Chiba, Japan
12 Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
13 Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
14 Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
15 School of Data Science, Kyoto Women’s University, Kyoto, Japan

DOI: 10.2478/jccm-2024-0028

Introduction: Early and accurate identification of high-risk patients with peripheral intravascular catheter (PIVC)-related phlebitis is vital to prevent medical device-related complications.
Aim of the study: This study aimed to develop and validate a machine learning-based model for predicting the incidence of PIVC-related phlebitis in critically ill patients.
Materials and methods: Four machine learning models were created using data from patients ≥ 18 years with a newly inserted PIVC during intensive care unit admission. Models were developed and validated using a 7:3 split. Random survival forest (RSF) was used to create predictive models for time-to-event outcomes. Logistic regression with least absolute reduction and selection operator (LASSO), random forest (RF), and gradient boosting decision tree were used to develop predictive models that treat outcome as a binary variable. Cox proportional hazards (COX) and logistic regression (LR) were used as comparators for time-to-event and binary outcomes, respectively.
Results: The final cohort had 3429 PIVCs, which were divided into the development cohort (2400 PIVCs) and validation cohort (1029 PIVCs). The c-statistic (95% confidence interval) of the models in the validation cohort for discrimination were as follows: RSF, 0.689 (0.627–0.750); LASSO, 0.664 (0.610–0.717); RF, 0.699 (0.645–0.753); gradient boosting tree, 0.699 (0.647–0.750); COX, 0.516 (0.454–0.578); and LR, 0.633 (0.575–0.691). No significant difference was observed among the c-statistic of the four models for binary outcome. However, RSF had a higher c-statistic than COX. The important predictive factors in RSF included inserted site, catheter material, age, and nicardipine, whereas those in RF included catheter dwell duration, nicardipine, and age.
Conclusions: The RSF model for the survival time analysis of phlebitis occurrence showed relatively high prediction performance compared with the COX model. No significant differences in prediction performance were observed among the models with phlebitis occurrence as the binary outcome.

Introduction: Although rarely diagnosed in the pediatric population, deep vein thrombosis (DVT) is experiencing a growing incidence, while continuously acquiring different nuances due to the widening range of risk factors and lifestyle changes in children and adolescents.
Case presentation: A 17-year-old female within four weeks after child delivery was admitted to our clinic due to a six-month history of pain in the left hypochondriac region. After a thorough evaluation, the presence of a benign splenic cyst was revealed, which was later surgically removed. Following the intervention, the patient developed secondary thrombocytosis and bloodstream infection which, together with pre-existing risk factors (obesity, compressive effect of a large cyst, the postpartum period, the presence of a central venous catheter, recent surgery, and post-operative mobilization difficulties) led to the occurrence of extensive DVT, despite anticoagulant prophylaxis and therapy with low-molecular-weight heparin.
Conclusions: DVT raises many challenges for the pediatrician, requiring a personalized approach. Although rare, pediatric patients with multiple concomitant high-risk factors should benefit from interdisciplinary care as DVT may not respond to standard therapy in such cases and rapidly become critical. Continual efforts to better understand and treat this condition will contribute to improved outcomes for pediatric patients affected by DVT.