Jonathan Elmer

Xiaobin Shen, Jonathan Elmer, George H. Chen · cmu

Patients resuscitated from cardiac arrest who enter a coma are at high risk of death. Forecasting neurological outcomes of these patients (the task of neurological prognostication) could help with treatment decisions. In this paper, we propose, to the best of our knowledge, the first dynamic framework for neurological prognostication of post-cardiac-arrest comatose patients using EEG data: our framework makes predictions for a patient over time as more EEG data become available, and different training patients' available EEG time series could vary in length. Predictions are phrased in terms of either time-to-event outcomes (time-to-awakening or time-to-death) or as the patient's probability of awakening or of dying across multiple time horizons. Our framework uses any dynamic survival analysis model that supports competing risks in the form of estimating patient-level cumulative incidence functions. We consider three competing risks as to what happens first to a patient: awakening, being withdrawn from life-sustaining therapies (and thus deterministically dying), or dying (by other causes). We demonstrate our framework by benchmarking three existing dynamic survival analysis models that support competing risks on a real dataset of 922 patients. Our main experimental findings are that: (1) the classical Fine and Gray model which only uses a patient's static features and summary statistics from the patient's latest hour's worth of EEG data is highly competitive, achieving accuracy scores as high as the recently developed Dynamic-DeepHit model that uses substantially more of the patient's EEG data; and (2) in an ablation study, we show that our choice of modeling three competing risks results in a model that is at least as accurate while learning more information than simpler models (using two competing risks or a standard survival analysis setup with no competing risks).

Brad Shook, Abby Turner, Jieshi Chen et al.

Time series foundation models (TSFMs) pretrained on data from multiple domains have shown strong performance on diverse modeling tasks. Various efforts have been made to develop foundation models specific to electroencephalography (EEG) data, which records brain electrical activity as time series. However, no comparative analysis of EEG-specific foundation models (EEGFMs) versus general TSFMs has been performed on EEG-specific tasks. We introduce a novel Spatial-Temporal Adapter with Multi-Head Pooling (STAMP), which leverages univariate embeddings produced by a general TSFM, implicitly models spatial-temporal characteristics of EEG data, and achieves performance comparable to state-of-the-art EEGFMs. A comprehensive analysis is performed on 8 benchmark datasets of clinical tasks using EEG for classification, along with ablation studies. Our proposed adapter is lightweight in trainable parameters and flexible in the inputs it can accommodate, supporting easy modeling of EEG data using TSFMs.

Yixin Zhou, Zhixiang Liu, Vladimir I. Zadorozhny et al.

Deep learning models have shown promise in EEG-based outcome prediction for comatose patients after cardiac arrest, but their reliability is often compromised by subtle forms of data leakage. In particular, when long EEG recordings are segmented into short windows and reused across multiple training stages, models may implicitly encode and propagate label information, leading to overly optimistic validation performance and poor generalization. In this study, we identify a previously overlooked form of data leakage in multi-stage EEG modeling pipelines. We demonstrate that violating strict patient-level separation can significantly inflate validation metrics while causing substantial degradation on independent test data. To address this issue, we propose a leakage-aware two-stage framework. In the first stage, short EEG segments are transformed into embedding representations using a convolutional neural network with an ArcFace objective. In the second stage, a Transformer-based model aggregates these embeddings to produce patient-level predictions, with strict isolation between training cohorts to eliminate leakage pathways. Experiments on a large-scale EEG dataset of post-cardiac-arrest patients show that the proposed framework achieves stable and generalizable performance under clinically relevant constraints, particularly in maintaining high sensitivity at stringent specificity thresholds. These results highlight the importance of rigorous data partitioning and provide a practical solution for reliable EEG-based outcome prediction.

Jakob Schoeffer, Maria De-Arteaga, Jonathan Elmer

The design of AI systems to assist human decision-making typically requires the availability of labels to train and evaluate supervised models. Frequently, however, these labels are unknown, and different ways of estimating them involve unverifiable assumptions or arbitrary choices. In this work, we introduce the concept of label indeterminacy and derive important implications in high-stakes AI-assisted decision-making. We present an empirical study in a healthcare context, focusing specifically on predicting the recovery of comatose patients after resuscitation from cardiac arrest. Our study shows that label indeterminacy can result in models that perform similarly when evaluated on patients with known labels, but vary drastically in their predictions for patients where labels are unknown. After demonstrating crucial ethical implications of label indeterminacy in this high-stakes context, we discuss takeaways for evaluation, reporting, and design.

Xiaobin Shen, Jonathan Elmer, George H. Chen · cmu

Prognostication for comatose post-cardiac arrest patients is a critical challenge that directly impacts clinical decision-making in the ICU. Clinical information that informs prognostication is collected serially over time. Shortly after cardiac arrest, various time-invariant baseline features are collected (e.g., demographics, cardiac arrest characteristics). After ICU admission, additional features are gathered, including time-varying hemodynamic data (e.g., blood pressure, doses of vasopressor medications). We view these as two phases in which we collect new features. In this study, we propose a novel stepwise dynamic competing risks model that improves the prediction of neurological outcomes by automatically determining when to take advantage of time-invariant features (first phase) and time-varying features (second phase). Notably, our model finds patients for whom this second phase (time-varying hemodynamic) information is beneficial for prognostication and also when this information is beneficial (as we collect more hemodynamic data for a patient over time, how important these data are for prognostication varies). Our approach extends the standard Fine and Gray model to explicitly model the two phases and to incorporate neural networks to flexibly capture complex nonlinear feature relationships. Evaluated on a retrospective cohort of 2,278 comatose post-arrest patients, our model demonstrates robust discriminative performance for the competing outcomes of awakening, withdrawal of life-sustaining therapy, and death despite maximal support. Our approach generalizes to more than two phases in which new features are collected and could be used in other dynamic prediction tasks, where it may be helpful to know when and for whom newly collected features significantly improve prediction.

Shubhranshu Shekhar, Dhivya Eswaran, Bryan Hooi et al.

Given a cardiac-arrest patient being monitored in the ICU (intensive care unit) for brain activity, how can we predict their health outcomes as early as possible? Early decision-making is critical in many applications, e.g. monitoring patients may assist in early intervention and improved care. On the other hand, early prediction on EEG data poses several challenges: (i) earliness-accuracy trade-off; observing more data often increases accuracy but sacrifices earliness, (ii) large-scale (for training) and streaming (online decision-making) data processing, and (iii) multi-variate (due to multiple electrodes) and multi-length (due to varying length of stay of patients) time series. Motivated by this real-world application, we present BeneFitter that infuses the incurred savings from an early prediction as well as the cost from misclassification into a unified domain-specific target called benefit. Unifying these two quantities allows us to directly estimate a single target (i.e. benefit), and importantly, dictates exactly when to output a prediction: when benefit estimate becomes positive. BeneFitter (a) is efficient and fast, with training time linear in the number of input sequences, and can operate in real-time for decision-making, (b) can handle multi-variate and variable-length time-series, suitable for patient data, and (c) is effective, providing up to 2x time-savings with equal or better accuracy as compared to competitors.