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artificial intelligence, in-hospital cardiac arrest, machine learning, Modified Early Warning Score, neural network



  1. Moffat, Laura M. DNP, APRN, AGCNS-BC, CMSRN
  2. Xu, Dongjuan PhD, RN


Purpose/Aims: Despite advances in healthcare, the incidence of in-hospital cardiac arrest (IHCA) has continued to rise for the past decade. Identifying those patients at risk has proven challenging. Our objective was to conduct a systematic review of the literature to compare the IHCA predictive performance of machine learning (ML) models with the Modified Early Warning Score (MEWS).


Design: The systematic review was conducted following the Preferred Reporting Items of Systematic Review and Meta-Analysis guidelines and registered on PROSPERO CRD42020182357.


Method: Data extraction was completed using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist. The risk of bias and applicability were evaluated using the Prediction model Risk of Bias Assessment Tool.


Results: Nine articles were included in this review that developed or validated IHCA prediction models and compared them with the MEWS. The studies by Jang et al and Kim et al showed that their ML models outperformed MEWS to predict IHCA with good to excellent predictive performance.


Conclusions: The ML models presented in this systematic review demonstrate a novel approach to predicting IHCA. All included studies suggest that ML models had similar or better predictive performance compared with MEWS. However, there is substantial variability in performance measures and concerns for risk of bias.