Detection of occult hemorrhage (i.e., internal bleeding) in patients in intensive care units (ICUs) can pose significant challenges for critical care workers. Because blood loss may not always be clinically apparent, clinicians rely on monitoring vital signs for specific trends indicative of a hemorrhage event. The inherent difficulties of diagnosing such an event can lead to late intervention by clinicians which has catastrophic consequences. Therefore, a methodology for early detection of hemorrhage has wide utility. We develop a Bayesian regime switching model (RSM) that analyzes trends in patients' vitals and labs to provide a probabilistic assessment of the underlying physiological state that a patient is in at any given time. This article is motivated by a comprehensive dataset we curated from Mayo Clinic of 33,924 real ICU patient encounters. Longitudinal response measurements are modeled as a vector autoregressive process conditional on all latent states up to the current time point, and the latent states follow a Markov process. We present a novel Bayesian sampling routine to learn the posterior probability distribution of the latent physiological states, as well as develop an approach to account for pre-ICU-admission physiological changes. A simulation and real case study illustrate the effectiveness of our approach.

Recent advances in the estimation of deep directed graphical models and recurrent networks let us contribute to the removal of a blind spot in the area of probabilistc modelling of time series. The proposed methods i) can infer distributed latent state-space trajectories with nonlinear transitions, ii) scale to large data sets thanks to the use of a stochastic objective and fast, approximate inference, iii) enable the design of rich emission models which iv) will naturally lead to structured outputs. Two different paths of introducing latent state sequences are pursued, leading to the variational recurrent auto encoder (VRAE) and the variational one step predictor (VOSP). The use of independent Wiener processes as priors on the latent state sequence is a viable compromise between efficient computation of the Kullback-Leibler divergence from the variational approximation of the posterior and maintaining a reasonable belief in the dynamics. We verify our methods empirically, obtaining results close or superior to the state of the art. We also show qualitative results for denoising and missing value imputation.