Early detection of bloodstream infection in critically ill children using artificial intelligence.

Background: Despite the high mortality associated with bloodstream infection (BSI), early detection of this condition is challenging in critical settings. The objective of this study was to create a machine learning tool for rapid recognition of BSI in critically ill children.

Methods: Data were extracted from a derivative cohort comprising patients who underwent at least one blood culture during hospitalization in the pediatric intensive care unit (PICU) of a tertiary hospital from January 2020 to June 2023 for model development. Data from another tertiary hospital were utilized for external validation. Variables selected for model development were age, white blood cell count with segmented neutrophil count, C-reactive protein, bilirubin, liver enzymes, glucose, body temperature, heart rate, and respiratory rate. Algorithms compared were extra trees, random forest, light gradient boosting, extreme gradient boosting, and CatBoost.

Results: We gathered 1,806 measurements and recorded 290 hospitalizations from 263 patients in the derivative cohort. Median age on admission was 43 months, with an interquartile range of 10-118.75 months, and a male predominance was observed (n=160, 55.2%). Candida albicans was the most prevalent pathogen, and median duration to confirm BSI was 3 days (range, 3-4). Patients with BSI experienced significantly higher in-hospital mortality and prolonged stays in the PICU than patients without BSI. Random forest classifier achieved the highest area under the receiver operating characteristic curve of 0.874 (0.762 for the validation set).

Conclusions: We developed a machine learning model that predicts BSI with acceptable performance. Further research is necessary to validate its effectiveness.