Prediction of mortality and resource utilization in critical care: a deep learning approach using multimodal electronic health records with natural language processing techniques

Background Predicting mortality and resource utilization from electronic health records (EHRs) is challenging yet crucial for optimizing patient outcomes and managing costs in intensive care unit (ICU). Existing approaches predominantly focus on structured EHRs, often ignoring the valuable clinical insights in free-text notes. Additionally, the potential of textual information within structured data is not fully leveraged. This study aimed to introduce and assess a deep learning framework using natural language processing techniques that integrates multimodal EHRs to predict mortality and resource utilization in critical care settings. Methods Utilizing two real-world EHR datasets, we developed and evaluated our model on three clinical tasks with leading existing methods. We also performed an ablation study on three key components in our framework: medical prompts, free-texts, and pre-trained sentence encoder. Furthermore, we assessed the model's robustness against the corruption in structured EHRs. Results Our experiments on two real-world datasets across three clinical tasks showed that our proposed model improved performance metrics by 1.6%/0.8% on BACC/AUROC for mortality prediction, 0.5%/2.2% on RMSE/MAE for LOS prediction, 10.9%/11.0% on RMSE/MAE for surgical duration estimation compared to the best existing methods. It consistently demonstrated superior performance compared to other baselines across three tasks at different corruption rates. Conclusions The proposed framework is an effective and accurate deep learning approach for predicting mortality and resource utilization in critical care. The study also highlights the success of using prompt learning with a transformer encoder in analyzing multimodal EHRs. Importantly, the model showed strong resilience to data corruption within structured data, especially at high corruption levels.