用临床概念命名时间区间,让重症预测模型更透明可解释。
INTERVenE: Temporal-Abstraction-Interval Based Transformers for Short-Horizon Medical Event Prediction

- 输入为基于医学本体的命名时间区间,而非原始数据或无名分段
- 在MIMIC-IV上达到0.672的加权AUPRC,优于最强基线0.041
- 支持逐令牌风险轨迹生成,适合临床决策可解释性研究
重症监护室电子健康记录预测模型需从稀疏且不规则的测量中学习,同时保留时间的临床意义并支持透明决策。我们提出INTERVenE,一类基于区间化知识型时间抽象(KBTA)的Transformer架构,其输入为来自精心构建医学本体的命名临床概念流(状态、趋势、事件、上下文),而非无名分段或原始测量三元组。该命名层使模型每个标记的归因在构造上对应临床概念。INTERVenE包含两种互补变体:自回归解码器可逐步生成未来抽象轨迹并输出风险读数(定位风险上升的时机及触发事件),双向编码器则支持单次遍历的联合风险与生存期预测。在57,078例MIMIC-IV入院患者数据上评估,与GRU-D、STraTS和KarmaLego相比,INTERVenE-Enc取得0.672的加权AUPRC,较最强神经基线提升0.041(非重叠95%置信区间),同时获得最佳加权AUROC(0.901)和住院时长平均绝对误差(44.4小时)。INTERVenE-Ar(AUROC_w 0.854,AUPRC_w 0.587)在更严格的生成读出任务下提供互补的令牌级风险轨迹。输入表示消融实验证明性能提升可跨结构离散化转移,确立了基于KBTA的时间区间作为可解释模型中实现临床概念对齐归因的基础。
原文摘要 · Abstract (English)
Electronic Health Record (EHR) prediction models in the intensive care unit must learn from sparse and irregular measurements while preserving the clinical meaning of time and supporting transparent decision-making. We present INTERVenE, a family of Transformer architectures whose input is an interval-based, knowledge-based temporal abstraction (KBTA), a token stream of named clinical concepts (states, trends, events, contexts) drawn from a curated medical ontology, rather than an unnamed bin index or a raw measurement triplet. This naming layer is what we ask KBTA to do: it makes the model's per-token attributions resolve to clinical concepts by construction. INTERVenE offers two complementary variants: an auto-regressive decoder that generates future abstraction trajectories with a per-step risk readout (localizing \emph{when} and \emph{after which events} risk rises), and a bidirectional encoder for single-pass joint risk and time-to-event prediction. Evaluated on 57,078 MIMIC-IV admissions against GRU-D, STraTS, and KarmaLego, INTERVenE-Enc reaches a support-weighted AUPRC$_w$ of 0.672, improving by 0.041 over the strongest neural baseline with non-overlapping 95\% bootstrap CIs, while also taking the best AUROC$_w$ (0.901) and length-of-stay MAE (44.4\,h). INTERVenE-Ar (AUROC$_w$ $0.854$, AUPRC$_w$ $0.587$ under the same evaluation contract - a strictly harder generative readout) provides a complementary token-level risk trajectory. An input-representation ablation confirms the lift transfers across structured discretizations, positioning KBTA-based intervals as the interpretable substrate that makes per-token attributions resolve to meaningful clinical concepts within the deployed model.
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