A Context-Adaptive Gated Embedding Framework for Advanced Clinical Decision-Making

초록

In intensive care units, large-scale clinical time-series data are continuously accumulated through electronic medical records and bedside monitoring systems. However, direct utilization of such data for clinical decision-making remains challenging due to irregular sampling, pervasive missingness, unstructured diagnostic information, and incomplete ICD labeling. Automated ICD coding constitutes an extreme multi-class classification problem with thousands of long-tailed categories, while intervention prediction tasks, such as mechanical ventilation management, involve rare transition events and severe class imbalance. To address these challenges, we propose CAGE, a hierarchical Clinical Decision Support System framework that integrates diagnosis, time-series signals, and intervention prediction. The framework first infers admission-level diagnostic context using a partial-label Automated ICD Coding module that combines DCNv2 with an Adaptive CLPL loss, producing probability-weighted diagnostic embeddings. These embeddings are subsequently fused with ICU time-series tensors and processed by a multi-branch Temporal Convolutional Network equipped with an ICD-conditioned gating mechanism to predict future ventilation state transitions. The experimental results demonstrate that DCNv2 achieves consistent superiority across all hit@k and probability concentration metrics for ICD coding. For intervention prediction, the proposed method substantially outperforms existing baselines, achieving a Macro-AUC of 98.2, Macro-AUPRC of 77.4, and F1-score of 79.4. These findings indicate that reinjecting diagnostic context as a conditioning variable, together with imbalance-aware loss design, effectively enhances rare-event detection and improves the practical applicability of clinical decision support systems.

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