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World J Crit Care Med. Jun 5, 2020; 9(2): 13-19
Published online Jun 5, 2020. doi: 10.5492/wjccm.v9.i2.13
Artificial intelligence and computer simulation models in critical illness
Amos Lal, Yuliya Pinevich, Ognjen Gajic, Vitaly Herasevich, Brian Pickering
Amos Lal, Ognjen Gajic, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, Mayo Clinic, MN 55905, United States
Amos Lal, Yuliya Pinevich, Ognjen Gajic, Vitaly Herasevich, Brian Pickering, Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, MN 55905, United States
Yuliya Pinevich, Vitaly Herasevich, Brian Pickering, Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Amos Lal, MBBS, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States. lal.amos@mayo.edu
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: March 28, 2020
Revised: April 21, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: June 5, 2020
Processing time: 156 Days and 12.6 Hours
Abstract

Widespread implementation of electronic health records has led to the increased use of artificial intelligence (AI) and computer modeling in clinical medicine. The early recognition and treatment of critical illness are central to good outcomes but are made difficult by, among other things, the complexity of the environment and the often non-specific nature of the clinical presentation. Increasingly, AI applications are being proposed as decision supports for busy or distracted clinicians, to address this challenge. Data driven “associative” AI models are built from retrospective data registries with missing data and imprecise timing. Associative AI models lack transparency, often ignore causal mechanisms, and, while potentially useful in improved prognostication, have thus far had limited clinical applicability. To be clinically useful, AI tools need to provide bedside clinicians with actionable knowledge. Explicitly addressing causal mechanisms not only increases validity and replicability of the model, but also adds transparency and helps gain trust from the bedside clinicians for real world use of AI models in teaching and patient care.

Keywords: Artificial intelligence; Digital twin; Critical illness; Predictive enrichment; Causation; Simulation models

Core tip: Widespread implementation of electronic health records coupled with increased computer power has led to the increased use of artificial intelligence and computer modeling in clinical medicine. To be clinically useful, artificial intelligence models need to be built on accurate data, take into consideration causal mechanisms, and provide actionable information at the point of care.