# From Single-Hospital to Multi-Centre Applications: Enhancing the Generalisability of Deep Learning Models for Adverse Event Prediction in the ICU

arXiv: https://arxiv.org/abs/2303.15354 · HTML: https://mlsanity.com/paper/2303.15354/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 14 of its 42 references that are in the map.
- First posted on arXiv 27 Mar 2023.

## Builds on (most cited first, 14 of 14)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [An Empirical Evaluation of Generic Convolutional and Recurrent Networks for Sequence Modeling](https://mlsanity.com/paper/1803.01271/) (2018)
- [On the Properties of Neural Machine Translation: Encoder-Decoder Approaches](https://mlsanity.com/paper/1409.1259/) (2014)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Deep CORAL: Correlation Alignment for Deep Domain Adaptation](https://mlsanity.com/paper/1607.01719/) (2016)
- [In Search of Lost Domain Generalization](https://mlsanity.com/paper/2007.01434/) (2020)
- [Learning to Generalize: Meta-Learning for Domain Generalization](https://mlsanity.com/paper/1710.03463/) (2017)
- [Out-of-Distribution Generalization via Risk Extrapolation (REx)](https://mlsanity.com/paper/2003.00688/) (2020)
- [The Future of Digital Health with Federated Learning](https://mlsanity.com/paper/2003.08119/) (2020)
- [Fishr: Invariant Gradient Variances for Out-of-Distribution Generalization](https://mlsanity.com/paper/2109.02934/) (2021)
- [HiRID-ICU-Benchmark -- A Comprehensive Machine Learning Benchmark on High-resolution ICU Data](https://mlsanity.com/paper/2111.08536/) (2021)
- [An Empirical Framework for Domain Generalization in Clinical Settings](https://mlsanity.com/paper/2103.11163/) (2021)
- [Predicting sepsis in multi-site, multi-national intensive care cohorts using deep learning](https://mlsanity.com/paper/2107.05230/) (2021)
- [Looking for Out-of-Distribution Environments in Multi-center Critical Care Data](https://mlsanity.com/paper/2205.13398/) (2022)

## Built on by (most cited first, 2 of 2)

- [Evaluation of Active Feature Acquisition Methods for Time-varying Feature Settings](https://mlsanity.com/paper/2312.01530/) (2023)
- [Robust Multicentre Detection and Classification of Colorectal Liver Metastases on CT: Application of Foundation Models](https://mlsanity.com/paper/2601.07585/) (2026)

## Abstract (arXiv)

Deep learning (DL) can aid doctors in detecting worsening patient states early, affording them time to react and prevent bad outcomes. While DL-based early warning models usually work well in the hospitals they were trained for, they tend to be less reliable when applied at new hospitals. This makes it difficult to deploy them at scale. Using carefully harmonised intensive care data from four data sources across Europe and the US (totalling 334,812 stays), we systematically assessed the reliability of DL models for three common adverse events: death, acute kidney injury (AKI), and sepsis. We tested whether using more than one data source and/or explicitly optimising for generalisability during training improves model performance at new hospitals. We found that models achieved high AUROC for mortality (0.838-0.869), AKI (0.823-0.866), and sepsis (0.749-0.824) at the training hospital. As expected, performance dropped at new hospitals, sometimes by as much as -0.200. Using more than one data source for training mitigated the performance drop, with multi-source models performing roughly on par with the best single-source model. This suggests that as data from more hospitals become available for training, model robustness is likely to increase, lower-bounding robustness with the performance of the most applicable data source in the training data. Dedicated methods promoting generalisability did not noticeably improve performance in our experiments.