arXiv subjects

Michael R. Pinsky

Publications and source records attributed to Michael R. Pinsky.

5 recordsLinked to original sources

arXiv2026

Learning a Continuous Sepsis Severity Score Without Hour-by-Hour Supervision: A Two-Site Retrospective Study

Currently used sepsis severity indices rely on fixed variables and weights established decades ago, which are coarsely discretized and calibrated to a cohort that no longer reflects contemporary critical care. No alternative learned directly from patient trajectories is in routine use. We conducted a retrospective two-cohort study on a total of 29,116 and 7,691 adult patients meeting Sepsis-3 criteria from two hospital systems in Massachusetts and Georgie, respectively. We developed a sepsis index using 43 routinely charted variables over a 72-hour treatment window. Unlike previous studies, we use mortality as a treatment-level ranking signal rather than a per-state target, allowing credit to be redistributed non-uniformly across timesteps. Evaluation was done on a permanent 20% test holdout, using clinical vignettes and Spearman correlation. Uncertainty intervals were obtained by bootstrap resampling of whole patients. Under this ranking scheme, non-survivors scored 1.19-1.64 points higher than survivors on a 0-10 scale within all strata of baseline SOFA-2, with similar results stratifying within lactate, mean arterial pressure (MAP), and creatinine. Within-patient change in the index correlated with change in lactate (Spearman rho = 0.39; n = 1,854). Similar, weaker correlations were found for MAP and creatinine. On a cohort level, cross-institutional agreement measured by Spearman correlation between models trained on different sites, were 70-77% of same-site correlation. External within-patient correlations were 0.54 and 0.59 against ceilings of 0.92 and 0.90. Our index also correlated with established indices, while null controls stayed near zero. Our index demonstrated hourly prognostic information that meaningfully separates patient outcomes and is consistent with clinical expectation, indicating potential as a decision support tool complementing clinical judgement.

cs.AI↗

arXiv2025

Automatic Cannulation of Femoral Vessels in a Porcine Shock Model

Rapid and reliable vascular access is critical in trauma and critical care. Central vascular catheterization enables high-volume resuscitation, hemodynamic monitoring, and advanced interventions like ECMO and REBOA. While peripheral access is common, central access is often necessary but requires specialized ultrasound-guided skills, posing challenges in prehospital settings. The complexity arises from deep target vessels and the precision needed for needle placement. Traditional techniques, like the Seldinger method, demand expertise to avoid complications. Despite its importance, ultrasound-guided central access is underutilized due to limited field expertise. While autonomous needle insertion has been explored for peripheral vessels, only semi-autonomous methods exist for femoral access. This work advances toward full automation, integrating robotic ultrasound for minimally invasive emergency procedures. Our key contribution is the successful femoral vein and artery cannulation in a porcine hemorrhagic shock model.

cs.RO↗

arXiv2021

Toward Robotically Automated Femoral Vascular Access

Advanced resuscitative technologies, such as Extra Corporeal Membrane Oxygenation (ECMO) cannulation or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), are technically difficult even for skilled medical personnel. This paper describes the core technologies that comprise a teleoperated system capable of granting femoral vascular access, which is an important step in both of these procedures and a major roadblock in their wider use in the field. These technologies include a kinematic manipulator, various sensing modalities, and a user interface. In addition, we evaluate our system on a surgical phantom as well as in-vivo porcine experiments. These resulted in, to the best of our knowledge, the first robot-assisted arterial catheterizations; a major step towards our eventual goal of automatic catheter insertion through the Seldinger technique.

cs.RO↗

arXiv2019

Characterization of Hemodynamic Signal by Learning Multi-View Relationships

Multi-view data are increasingly prevalent in practice. It is often relevant to analyze the relationships between pairs of views by multi-view component analysis techniques such as Canonical Correlation Analysis (CCA). However, data may easily exhibit nonlinear relations, which CCA cannot reveal. We aim to investigate the usefulness of nonlinear multi-view relations to characterize multi-view data in an explainable manner. To address this challenge, we propose a method to characterize globally nonlinear multi-view relationships as a mixture of linear relationships. A clustering method, it identifies partitions of observations that exhibit the same relationships and learns those relationships simultaneously. It defines cluster variables by multi-view rather than spatial relationships, unlike almost all other clustering methods. Furthermore, we introduce a supervised classification method that builds on our clustering method by employing multi-view relationships as discriminative factors. The value of these methods resides in their capability to find useful structure in the data that single-view or current multi-view methods may struggle to find. We demonstrate the potential utility of the proposed approach using an application in clinical informatics to detect and characterize slow bleeding in patients whose central venous pressure (CVP) is monitored at the bedside. Presently, CVP is considered an insensitive measure of a subject's intravascular volume status or its change. However, we reason that features of CVP during inspiration and expiration should be informative in early identification of emerging changes of patient status. We empirically show how the proposed method can help discover and analyze multiple-to-multiple correlations, which could be nonlinear or vary throughout the population, by finding explainable structure of operational interest to practitioners.

stat.ML↗

arXiv2019

Detecting Patterns of Physiological Response to Hemodynamic Stress via Unsupervised Deep Learning

Monitoring physiological responses to hemodynamic stress can help in determining appropriate treatment and ensuring good patient outcomes. Physicians' intuition suggests that the human body has a number of physiological response patterns to hemorrhage which escalate as blood loss continues, however the exact etiology and phenotypes of such responses are not well known or understood only at a coarse level. Although previous research has shown that machine learning models can perform well in hemorrhage detection and survival prediction, it is unclear whether machine learning could help to identify and characterize the underlying physiological responses in raw vital sign data. We approach this problem by first transforming the high-dimensional vital sign time series into a tractable, lower-dimensional latent space using a dilated, causal convolutional encoder model trained purely unsupervised. Second, we identify informative clusters in the embeddings. By analyzing the clusters of latent embeddings and visualizing them over time, we hypothesize that the clusters correspond to the physiological response patterns that match physicians' intuition. Furthermore, we attempt to evaluate the latent embeddings using a variety of methods, such as predicting the cluster labels using explainable features.

cs.LG↗