Derivation and validation of a bayesian network to predict pretest probability of venous thromboembolism

Jeffrey A. Kline, Andrew J. Novobilski, Christopher Kabrhel, Peter B. Richman, D. Mark Courtney

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Study objective: A Bayesian network can estimate a numeric pretest probability of venous thromboembolism on the basis of values of clinical variables. We determine the accuracy with which a Bayesian network can identify patients with a low pretest probability of venous thromboembolism, defined as less than or equal to 2%. Methods: Using commercial software, we derived a population of Bayesian networks from 25 input variables collected on 3,145 emergency department (ED) patients with suspected venous thromboembolism who underwent standardized testing, including pulmonary vascular imaging, and 90-day follow-up (11.0% of patients were venous thromboembolism positive). The best-fit Bayesian network was selected using a genetic algorithm. The selected Bayesian network was tested in a validation population of 1,423 ED patients prospectively evaluated for venous thromboembolism, including 90-day follow-up (8.0% were venous thromboembolism positive). The Bayesian network probability estimate was normalized to a score of 0% to 100%. Results: Of 1,423 patients in the validation cohort, 711 (50%; 95% confidence interval [CI] 47% to 52%) had a score less than or equal to 2% that predicted a low pretest probability. Of these 711 patients, 700 (98.5%; 95% CI 97.2% to 99.2%) had no venous thromboembolism at follow-up. Conclusion: A Bayesian network, derived and independently validated in ED populations, identified half of the validation cohort as having a low pretest probability (≤2%); 98.5% of these patients were correctly classified by the network.

Original languageEnglish (US)
Pages (from-to)282-290
Number of pages9
JournalAnnals of Emergency Medicine
Volume45
Issue number3
DOIs
StatePublished - Mar 2005
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine

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