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stat.APstat.MEstat.ML Emmett B. Kendall, Jonathan P. Williams, Curtis B. Storlie et al. · Mar 23, 2026

This paper addresses the critical challenge of detecting occult hemorrhage (internal bleeding) in intensive care units, where delayed diagnosis leads to preventable physiological shock and death. The authors develop a Bayesian regime switching model (RSM) that tracks five latent physiological states—including stable, hemorrhage, and recovery—using longitudinal vital signs (heart rate, MAP, hemoglobin, lactate) and medication history. Applied to 33,924 Mayo Clinic ICU encounters, the model aims to provide interpretable, probabilistic early warnings that outperform standard vital sign monitoring by accounting for autoregressive trends and pre-admission physiological changes.

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.