What is Hiding in Medicine's Dark Matter? Learning with Missing Data in Medical Practices

Electronic patient records (EPRs) produce a wealth of data but contain significant missing information. Understanding and handling this missing data is an important part of clinical data analysis and if left unaddressed could result in bias in analysis and distortion in critical conclusions. Missing data may be linked to health care professional practice patterns and imputation of missing data can increase the validity of clinical decisions. This study focuses on statistical approaches for understanding and interpreting the missing data and machine learning based clinical data imputation using a single centre's paediatric emergency data and the data from UK's largest clinical audit for traumatic injury database (TARN). In the study of 56,961 data points related to initial vital signs and observations taken on children presenting to an Emergency Department, we have shown that missing data are likely to be non-random and how these are linked to health care professional practice patterns. We have then examined 79 TARN fields with missing values for 5,791 trauma cases. Singular Value Decomposition (SVD) and k-Nearest Neighbour (kNN) based missing data imputation methods are used and imputation results against the original dataset are compared and statistically tested. We have concluded that the 1NN imputer is the best imputation which indicates a usual pattern of clinical decision making: find the most similar patients and take their attributes as imputation.