Nothing Special   »   [go: up one dir, main page]

skip to main content
article

A belief rule-based expert system to assess suspicion of acute coronary syndrome (ACS) under uncertainty

Published: 01 November 2018 Publication History

Abstract

Acute coronary syndrome (ACS) is responsible for the obstruction of coronary arteries, resulting in the loss of lives. The onset of ACS can be determined by looking at the various signs and symptoms of a patient. However, the accuracy of ACS determination is often put into question since there exist different types of uncertainties with the signs and symptoms. Belief rule-based expert systems (BRBESs) are widely used to capture uncertain knowledge and to accomplish the task of reasoning under uncertainty by employing belief rule base and evidential reasoning. This article presents the process of developing a BRBES to determine ACS predictability. The BRBES has been validated against the data of 250 patients suffering from chest pain. It is noticed that the outputs created from the BRBES are more dependable than that of the opinion of cardiologists as well as other two expert system tools, namely artificial neural networks and support vector machine. Hence, it can be argued that the BRBES is capable of playing an important role in decision making as well as in avoiding costly laboratory investigations. A procedure to train the system, allowing its enhancement of performance, is also presented.

References

[1]
Akgundogdu A, Kurt S, Kilic N, Ucan ON, Akalin N (2010) Diagnosis of renal failure disease using adaptive neuro-fuzzy inference system. J Med Syst 34(6):1003-1009.
[2]
Arslanian-Engoren C, Patel A, Fang J, Armstrong D, Kline-Rogers E, Duvernoy CS, Eagle KA (2006) Symptoms of men and women presenting with acute coronary syndromes. Am J Cardiol 98(9):1177-1181.
[3]
Avci E (2012) A new expert system for diagnosis of lung cancer: GDALS_SVM. J Med Syst 36(3):2005-2009.
[4]
Bassand J-P, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, Fox KA, Hasdai D, Ohman EM, Wallentin L, Wijns W (2007) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 28(13):1598-1660.
[5]
Bates DW, Cohen M, Leape LL, Overhage JM, Shabot MM, Sheridan T (2001) Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc 8(4):299-308.
[6]
Berner ES, La Lande TJ (2007) Overview of clinical decision support systems. In: Berner ES (ed) Clinical decision support systems: theory and practice, 2nd edn. Springer, New York.
[7]
Bertsche T, Askoxylakis V, Habl G, Laidig F, Kaltschmidt J, Schmitt SP, Ghaderi H, Bois AZ, Milker-Zabel S, Debus J, Bardenheuer HJ, Haefeli WE (2009) Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients. Pain 147(1-3):20-28.
[8]
Body R (2009) Clinical decision rules to enable exclusion of acute coronary syndromes in Emergency Department patients with chest pain. Manchester Metropolitan University, Manchester, UK, Faculty of Health, Psychology and Social Care.
[9]
Buchanan B, Shortliffe E (1984) Rule-based expert systems: the MYCIN experiments of the stanford heuristic programming project. Addison-Wesley, Reading, Massachusetts.
[10]
Cannon CP, Battler A, Brindis RG, Cox JL, Ellis SG, Every NR, Flaherty JT, Harrington RA, Krumholz HM, Simoons ML, De V, Werf FJ, Weintraub WS, Mitchell KR, Morrisson SL, Brindis RG, Anderson HV, Cannom DS, Chitwood WR, Cigarroa JE, Collins-Nakai RL, Ellis SG, Gibbons RJ, Grover FL, Heidenreich PA, Khandheria BK, Knoebel SB, Krumholz HL, Malenka DJ, Mark DB, Mckay CR, Passamani ER, Radford MJ, Riner RN, Schwartz JB, Shaw RE, Shemin RJ, Van FDB, Verrier ED, Watkins MW, Phoubandith DR, Furnelli T (2001) American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology task force on clinical data standards (acute coronary syndromes writing committee). J Am Coll Cardiol 38(7):2114-2130.
[11]
Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, Ornato JP, Barron HV, Kiefe CI (2000) Prevalence, clinical characteristics and mortality among patients with Atypical symptoms of ACS 171 myocardial infarction presenting without chest pain. JAMA 283(24):3223-3229.
[12]
Chai R, Ling SH, Hunter GP, Tran Y, Nguyen HT (2014) Brain-computer interface classifier for wheelchair commands using neural network with fuzzy particle swarm optimization. IEEE J Biomed Health Inform 18(5):1614-1624.
[13]
Chen Y-W, Yang J-B, Xu D-L (2013a) Uncertain nonlinear system modeling and identification using belief rule-based systems. In: Proc. IUKM 2013, pp 209-218.
[14]
Chen Y-W, Yang J-B, Xu D-L, Yang S-L (2013b) On the inference and approximation properties of belief rule based systems. Inf Sci 234:121-135.
[15]
Chen HL, Yang B, Wang G, Liu J, Chen YD, Liu DY (2012) A three-stage expert system based on support vector machines for thyroid disease diagnosis. J Med Syst 36(3):1953-1963.
[16]
Davidson S, Walker BR (ed), Ralston SH (ed), Colledge NR (2010) Davidsons principles and practice of medicine, 21st edn, Chapter 18. ISBN-13: 978-0-7020-3084-0.
[17]
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837-845.
[18]
DeVon HA, Ryan CJ (2005) Chest pain and associated symptoms of acute coronary syndromes. J Cardiovasc Nurs 20(4):232-238.
[19]
Fearn P, Regan K, Sculli F, Fajardo J, Smith B, Alli P (2007) Lessons learned from caisis: an open source, web-based system for integrating clinical practice and research. In: Proc. CBMS '07.
[20]
Fuster V, Kovacic JC (2014) Acute coronary syndromes: pathology, diagnosis, genetics, prevention, and treatment. Circ Res 114(12):1847-1851.
[21]
Gago P, Silva Á, Santos MF (2007) Adaptive decision support for intensive care. Proc EPIA 2017:415-425.
[22]
Graham TA, Bullard MJ, Kushniruk AW, Holroyd BR, Rowe BH (2008) Assessing the sensibility of two clinical decision support systems. J Med Syst 32(5):361-368.
[23]
Grams RR (1993) Clinical laboratory test reference (CLTR). J Med Syst 17(2):59-67.
[24]
Hanley JA (1988) The robustness of the "Binormal" assumptions used in fitting ROC curves. Med Decis Making 8(3):197-203.
[25]
Herbst MD, Garcia EV, Cooke CD, Ezquerra NF, Folks RD, DePuey EG (1992) Myocardial ischemia detection by expert system interpretation of thallium-201 tomograms. In: Reiber JHC, van der Wall EE (eds) Cardiovascular nuclear medicine and MRI. Kluger Academic Publishers, Dordrecht, pp 77-88.
[26]
Huang M-J, Chen M-Y (2007) Integrated design of the intelligent web-based Chinese Medical Diagnostic System (CMDS)--systematic development for digestive health. Expert Syst Appl 32(2):658-673.
[27]
Issac Niwas S, Palanisamy P, Chibbar R, Zhang WJ (2012) An expert support system for breast cancer diagnosis using color wavelet features. J Med Syst 36(5):3091-3102.
[28]
Jonsbu J, Aase O, Rollag A, Liestøl K, Erikssen J (1993) Prospective evaluation of an EDB-based diagnostic program to be used in patients admitted to hospital with acute chest pain. Eur Heart J 14(4):441-446.
[29]
Kawamoto K, Houlihan CA, Balas EA, Lobach DF (2005) Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330:765-772.
[30]
Kong G (2011) An online belief rule-based group clinical decision support system, Doctor of Philosophy Thesis, Manchester Business School, University of Manchester, UK.
[31]
Kong G, Xu D-L, Yang J-B (2008) Clinical decision support systems: a review on knowledge representation and inference under uncertainties. Int J Comput Intell Syst 1(2):159-167.
[32]
Kong GL, Xu DL, Yang JB (2009) An evidence-adaptive belief rule-based decision support system for clinical risk assessment in emergency care. In: Proc. 23rd European Conference on Operational Research, Bonn, Germany.
[33]
Kumar A, Cannon CP (2009) Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc 84(10):917-938.
[34]
Kumar KA, Singh Y, Sanyal S (2009) Hybrid approach using case-based reasoning and rule-based reasoning for domain independent clinical decision support in ICU. Expert Syst Appl 36(1):65-71.
[35]
Lansky AJ, Ng VG, Meller S, Xu K, Fahy M, Feit F, Ohman EM, White HD, Mehran R, Bertrand ME, Desmet W, Hamon M, Stone GW (2014) Impact of nonculprit vessel myocardial perfusion on outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes: analysis from the ACUITY trial (acute catheterization and urgent intervention triage strategy). JACC Cardiovasc Interv 7(3):266-275.
[36]
Lin L, Hu PJ-H, Sheng ORL (2006) A decision support system for lower back pain diagnosis: uncertainty management and clinical evaluations. Decis Support Syst 42(2):1152-1169.
[37]
Lin C, Lin CM, Lin B, Yang M-C (2009) A decision support system for improving doctors' prescribing behavior. Expert Syst Appl 36(4):7975-7984.
[38]
Liu TI, Singonahalli JH, Iyer NR (1996) Detection of roller bearing defects using expert system and fuzzy logic. Mech Syst Signal Process 10(5):595-614.
[39]
Liu J, Chen S, Martinez L, Wang H (2013) A belief rule-based generic risk assessment framework. Decis Aid Models Disaster Manag Emergencies Atl Comput Intell Syst 7:145-169.
[40]
Mack EH, Wheeler DS, Embi PJ (2009) Clinical decision support systems in the pediatric intensive care unit. Pediatr Crit Care Med 10(1):23-28.
[41]
Mark DB, Talley JD, Topol EJ, Bowman L, Lam LC, Anderson KM, Jollis JG, Cleman MW, Lee KL, Aversano T, Untereker WJ, Davidson-Ray L, Califf RM (1996) Economic assessment of platelet glycoprotein IIb/IIIa inhibition for prevention of ischemic complications of high-risk coronary angioplasty. EPIC Investigators. Circulation 94(4):629-635.
[42]
Menachemi N, Saunders C, Chukmaitov A, Matthews MC, Brooks RG (2007) Hospital adoption of information technologies and improved patient safety: a study of 98 hospitals in Florida. J Healthc Manag 52(6):398-410.
[43]
Metz CE (1978) Basic principles of ROC analysis. Semin Nucl Med 8(4):283-298.
[44]
Murray CJ, Lopez AD (1997) Alternative projections of mortality and disability by cause 19902020: global burden of disease study. Lancet 349(9064):1498-1504.
[45]
Musen MA, Middleton B, Greenes RA (2014) Clinical decision-support systems. In: Shortliffe E, Cimino J (eds) Biomedical informatics. Springer, London.
[46]
Myers J, de Souza CR, Borghi-Silva A, Guazzi M, Chase P, Bensimhon D, Peberdy MA, Ashley E,West E, Cahalin LP, Forman D, Arena R (2014) A neural network approach to predicting outcomes in heart failure using cardiopulmonary exercise testing. Int J Cardiol 171(2):265-269.
[47]
National Collaborating Centre for Chronic Conditions (2003) chronic heart failure: national clinical guideline for diagnosis and management in primary and secondary care. national collaborating centre for chronic conditions, Royal College of Physicians (UK). ISBN 1-86016-188-X.
[48]
Patra S, Bruzzone L (2012) A batch-mode active learning technique based on multiple uncertainty for SVM classifier. IEEE Geosci Remote Sens Lett 9(3):497-501.
[49]
Piury J, Laita LM, Roanes-Lozano E, Hernando A, Piury-Alonso FJ, Gómez-Argüelles JM, Laita L (2012) A Gröbner bases-based rule based expert system for fibromyalgia diagnosis. RACSAM 106(2):443-456.
[50]
Pressman RS (2005) Software Engineering: a Practitioners Approach, 5th edn. McGraw-Hill Series in Computer Science, pp 373-374. ISBN 0-07-365578-3.
[51]
Reason J (2001) Understanding adverse events: the human factor. In: Charles V (ed) Clinical risk management: enhancing patient safety, 2nd edn. BMJ publishing house, London.
[52]
Roukema J, Steyerberg EW, van der Lei J, Moll HA (2008) Randomized trial of a clinical decision support system: impact on the management of children with fever without apparent source. J Am Med Inform Assoc 15(1):107-113.
[53]
Russell S, Norvig P (2009) Artificial intelligence: a modern approach, 3rd edn. Prentice Hall, Upper Saddle River, ISBN 0-13-604259-7.
[54]
Sari M, Gulbandilar E, Cimbiz AJ (2012) Prediction of low back pain with two expert systems. J Med Syst 36(3):1523-1527.
[55]
Shortliffe EH (1976) Computer-based medical consultations: MYCIN. Elsevier, New York.
[56]
Sim I, Gorman P, Greenes RA, Haynes RB, Kaplan B, Lehmann H, Tang PC (2001) Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc 8(6):527-534.
[57]
Skalská H, Freylich V (2006) Web-bootstrap estimate of area under ROC curve. Austrian J Stat 35(2-3):325-330.
[58]
Spooner SA (2007) Mathematical foundations of decision support systems. In: Berner ES (ed) Clinical decision support systems: theory and practice, 2nd edn. Springer, New York.
[59]
Wang Y-M, Yang J-B, Xu D-L (2006) Environmental impact assessment using the evidential reasoning approach. Eur J Oper Res 174(3):1885-1913.
[60]
Warner HR Jr (1989) Iliad: moving medical decision-making into new frontiers. Methods Inf Med 28(4):370-372.
[61]
Weintraub WS, Mauldin PD, Becker E, Kosinski AS, King SBIII (1995) A comparison of the costs of and quality of life after coronary angioplasty or coronary surgery for multivessel coronary artery disease. Results from the emory angioplasty versus surgery trial (EAST). Circulation 92(10):2831-2840.
[62]
Wiederhold G, Fagan L, Shortliffe E, Perreault L (2001) Medical informatics: computer applications in health care and biomedicine, 2nd edn. Springer, New York, p 854.
[63]
Wu T-K, Huang S-C, Meng Y-R (2008) Evaluation of ANN and SVM classifiers as predictors to the diagnosis of students with learning disabilities. Expert Syst Appl 34(3):1846-1856.
[64]
Xu D-L, Liu J, Yang J-B, Liu G-P, Wang J, Jenkinson I, Ren J (2007) Inference and learning methodology of belief-rule-based expert system for pipeline leak detection. Expert Syst Appl 32(1):103-113.
[65]
Yang J-B (2001) Rule and utility based evidential reasoning approach for multi-attribute decision analysis under uncertainties. Eur J Oper Res 131(1):31-61.
[66]
Yang J-B, Sen P (1994) A general multi-level evaluation process for hybrid MADM with uncertainty. IEEE Trans Syst Man Cybern 24(10):1458-1473.
[67]
Yang J-B, Singh MG (1994) An evidential reasoning approach for multiple-attribute decision making with uncertainty. IEEE Trans Syst Man Cybern 24(1):1-18.
[68]
Yang JB, Liu J, Wang J, Sii H-S, Wang H-W (2006) Belief rule-base inference methodology using the evidential reasoning approach-RIMER. IEEE Trans Syst Man Cybern Part A Syst Hum 36(2):266-285.
[69]
Yang JB, Liu J, Xu DL, Wang J, Wang HW (2007) Optimal learning method for training belief rule based systems. IEEE Trans Syst Man Cybern Part A Syst Hum 37(4):569-585.
[70]
Yuan Y, Feldhamer S, Gafni A, Fyfe F, Ludwin D (2002) The development and evaluation of a fuzzy logic expert system for renal transplantation assignment: is this a useful tool? Eur J Oper Res 142(1):152-173.
[71]
Zdzienicka J, Siudak Z, Zawislak B, Dziewierz A, Rakowski T, Dubiel J, Dudek D (2007) Patients with non-ST-elevation myocardial infarction and without chest pain are treated less aggressively and experience higher in-hospital mortality. Kardiol Pol 65(7):769-775.
[72]
Zhou Z-J, Hu C-H, Yang J-B, Xu D-L, Zhou D-H (2009) Online updating belief rule based system for pipeline leak detection under expert intervention. Expert Syst Appl 36(4):7700-7709.
[73]
Zhou Z-J, Hu C-H, Yang J-B, Xu D-L, Chen M-Y, Zhou D-H (2010) A sequential learning algorithm for online constructing belief-rule-based systems. Expert Syst Appl 37(2):1790-1799.

Cited By

View all
  • (2021)A novel nonlinear causal inference approach using vector‐based belief rule baseInternational Journal of Intelligent Systems10.1002/int.2250036:9(5005-5027)Online publication date: 3-Jun-2021

Recommendations

Comments

Please enable JavaScript to view thecomments powered by Disqus.

Information & Contributors

Information

Published In

cover image Soft Computing - A Fusion of Foundations, Methodologies and Applications
Soft Computing - A Fusion of Foundations, Methodologies and Applications  Volume 22, Issue 22
November 2018
350 pages
ISSN:1432-7643
EISSN:1433-7479
Issue’s Table of Contents

Publisher

Springer-Verlag

Berlin, Heidelberg

Publication History

Published: 01 November 2018

Author Tags

  1. Acute coronary syndrome (ACS)
  2. Belief rule base
  3. Expert system
  4. Signs and symptoms
  5. Suspicion
  6. Uncertainty

Qualifiers

  • Article

Contributors

Other Metrics

Bibliometrics & Citations

Bibliometrics

Article Metrics

  • Downloads (Last 12 months)0
  • Downloads (Last 6 weeks)0
Reflects downloads up to 20 Nov 2024

Other Metrics

Citations

Cited By

View all
  • (2021)A novel nonlinear causal inference approach using vector‐based belief rule baseInternational Journal of Intelligent Systems10.1002/int.2250036:9(5005-5027)Online publication date: 3-Jun-2021

View Options

View options

Login options

Media

Figures

Other

Tables

Share

Share

Share this Publication link

Share on social media