A Deep Learning Model for the Diagnosis and Discrimination of Gram-Positive and Gram-Negative Bacterial Pneumonia for Children Using Chest Radiography Images and Clinical Information

Abstract

Purpose

This study aimed to develop a deep learning model based on chest radiography (CXR) images and clinical data to accurately classify gram-positive and gram-negative bacterial pneumonia in children to guide the use of antibiotics.

Methods

We retrospectively collected CXR images along with clinical information for gram-positive (n=447) and gram-negative (n=395) bacterial pneumonia in children from January 1, 2016, to June 30, 2021. Four types of machine learning models based on clinical data and six types of deep learning algorithm models based on image data were constructed, and multi-modal decision fusion was performed.

Results

In the machine learning models, CatBoost, which only used clinical data, had the best performance; its area under the receiver operating characteristic curve (AUC) was significantly higher than that of the other models (P<0.05). The incorporation of clinical information improved the performance of deep learning models that relied solely on image-based classification. Consequently, AUC and F1 increased by 5.6% and 10.2% on average, respectively. The best quality was achieved with ResNet101 (model accuracy: 0.75, recall rate: 0.84, AUC: 0.803, F1: 0.782).

Conclusion

Our study established a pediatric bacterial pneumonia model that utilizes CXR and clinical data to accurately classify cases of gram-negative and gram-positive bacterial pneumonia. The results confirmed that the addition of image data to the convolutional neural network model significantly improved its performance. While the CatBoost-based classifier had greater advantages owing to a smaller dataset, the quality of the Resnet101 model trained using multi-modal data was comparable to that of the CatBoost model, even with a limited number of samples.

Keywords:

• pediatrics
• antibiotics
• clinical data
• X-ray
• multi-modal data

Abbreviations

CXR, Chest radiography; AUC, Area under the receiver operating characteristic curve; CNN, Convolutional neural network; MSE, Mean squared error; SGD, Stochastic gradient descent.

Disclosure

The authors of this article declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors declare that they have no competing interests.

Additional information

Funding

This study has received funding from major science and technology projects of Chongqing City (Grant No. cstc2018jszx-cyztzxX0017), Young and Middle-aged Medical Talents Foundation Project of Chongqing (Grant No. 414Z395),National Natural Science Foundation of China (NSFC) (grant No. 82071910), Emergency Project for Technological Breakthrough in Clinical Treatment of Hospital-acquired COVID-19 Infection in 2023(2023XGIIT07),the Youth Training Project of Medical Science and Technology (Grant No. 20QNPY012).