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ASA Physical Status Classification Using NLP Models

This repository contains code and resources for the paper "Comparison of NLP Machine Learning Models with Human Physicians for ASA Physical Status Classification", published in npj Digital Medicine (2024): https://doi.org/10.1038/s41746-024-01259-6. The study introduces natural language processing (NLP) models to classify ASA (American Society of Anesthesiologists) Physical Status (ASA-PS) using pre-anesthesia evaluation summaries and compares the performance with human physicians.

Overview

ASA-PS classification is crucial for assessing patients' comorbidities prior to surgery, but it has traditionally suffered from inter-rater variability among healthcare professionals. This project aims to mitigate this inconsistency by automating ASA-PS classification using cutting-edge NLP models.

The study involved training and comparing three NLP models:

  • ClinicalBigBird
  • BioClinicalBERT
  • GPT-4

ClinicalBigBird emerged as the best-performing model, surpassing both human anesthesiologists and other models in terms of specificity, precision, and F1-score.

Features

  • NLP-based ASA-PS classification: Uses pre-anesthesia free-text summaries to assign ASA-PS classes.
  • Model comparison: Performance is evaluated against anesthesiology residents and board-certified anesthesiologists.
  • Shapley value-based interpretability: The repository includes code for generating Shapley plots to visualize the contribution of each word in the text towards ASA-PS classification.

Data

The dataset contains 717,389 surgical cases from a tertiary academic hospital, covering surgeries between October 2004 and May 2023. Data was split into training, tuning, and test sets, with tuning and test datasets labeled by a consensus of board-certified anesthesiologists.

Models

  1. ClinicalBigBird: Specialized for processing long clinical texts (up to 4096 tokens) and fine-tuned for ASA-PS classification. Achieved the best performance with AUROC scores above 0.91.
  2. BioClinicalBERT: Biomedical-domain-specific BERT model, but limited to 512 tokens.
  3. GPT-4: Demonstrated high accuracy in medical exams, but less optimized for ASA-PS classification.

Training the ClinicalBigBird Model for MLM

The provided code demonstrates how to fine-tune the ClinicalBigBird model for a masked language modeling (MLM) task using a custom trainer to handle imbalanced datasets.

Code Overview

The training script includes:

  • Loading a pre-trained ClinicalBigBird model.
  • Defining TrainingArguments including parameters such as batch size, learning rate, and number of epochs.
  • Using a custom trainer class with an ImbalancedDatasetSampler to handle imbalanced datasets during training.
  • The model is trained on a dataset with a masked language modeling (MLM) task using a mask probability of 0.15.

Requirements

  • Python 3.10+
  • PyTorch
  • Transformers (Hugging Face)
  • Datasets (Hugging Face)
  • torchsampler (for imbalanced dataset sampling)
  • Other dependencies listed in requirements.txt

Installation

Clone the repository and install the dependencies:

git clone https://github.com/jipyeong-lee/ASA-PS-NLP-vs-Human-Physicians.git
cd ASA-PS-NLP-vs-Human-Physicians
pip install -r requirements.txt

Citation

If you use this code or data, please cite the original paper:

@article{Yoon2024ASAPSClassification,
  title={Comparison of NLP Machine Learning Models with Human Physicians for ASA Physical Status Classification},
  author={Soo Bin Yoon, Jipyeong Lee, Hyung-Chul Lee, Chul-Woo Jung, Hyeonhoon Lee},
  journal={npj Digital Medicine},
  year={2024},
  doi={10.1038/s41746-024-01259-6}
}

License

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third-party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.