We then determine whether the patient was admitted to the hospital or not, reflecting the emergency physician’s triage decision: did the patient need close monitoring as an inpatient, or were they safe to go home? Finally, we obtain two critical outcomes: whether the patient ultimately required mechanical ventilation over the 14 days after the initial visit and did they die over the same period. Joseph, in patients diagnosed with Covid-19. We begin by identifying chest x-rays performed in the ER across the 51 hospitals at Providence St. The dataset consists of patients who were received in the Emergency Department (ED) of a participating hospital and received a chest X-ray and either a positive COVID-19 diagnosis (via physician) or a positive test (rapid, antibody, or PCR) within fourteen days of their ED visit date. This is directly motivated by the Covid-19 pandemic, but if it works, it could help a range of other patients with respiratory infections that progress via the same “final common pathway”-acute respiratory distress syndrome (ARDS): influenza, pneumonia, sepsis, and non-infectious inflammatory conditions. This dataset links chest x-rays to pulmonary outcomes, in order to fill an urgent need identified by clinicians: an algorithm that helps physicians make good triage decisions, by predicting pulmonary collapse on the basis of x-rays done in the ER. Indeed, some health systems explicitly require senior physicians to personally review x-rays before a patient is sent home from the ER, in the hope that expending their scarcest resource-doctors’ time-can help catch high-risk patients in time. But this signal can be devilishly hard to find. It’s clear to front-line doctors that there is a signal in the x-ray image for predicting impending pulmonary collapse. The key to solving this problem could lie in the chest x-ray, a rapid, cheap diagnostic that nearly all patients with respiratory complaints get in the ER. Other patients look well enough to be sent home, only to deteriorate rapidly, returning to the ER in profound respiratory distress-or not returning at all. Empirically, many patients are admitted to the hospital, but ultimately do not require advanced care-a waste of beds. Reports from the front lines of the Covid-19 pandemic indicate that the current state of medical knowledge is failing here. In emergency rooms across the world, doctors facing hospital bed shortages must make a difficult judgment call: is a patient with respiratory infection safe to go home? Or is close monitoring in the hospital, or even the ICU, needed? Getting this right is critical not just to save lives, but also to optimize scarce hospital resources. “Solving Medicine’s Data Bottleneck: Nightingale Open Science.” Nature Medicine 28, no. “Solving Medicine’s Data Bottleneck: Nightingale Open Science.” Nature Medicine, vol. MLA Mullainathan, Sendhil, and Ziad Obermeyer. Solving medicine’s data bottleneck: Nightingale Open Science.
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