Using self-supervised feature learning to improve the use of pulse oximeter signals to predict paediatric hospitalization [version 2; peer review: 2 approved]

Background: The success of many machine learning applications depends on knowledge about the relationship between the input data and the task of interest (output), hindering the application of machine learning to novel tasks. End-to-end deep learning, which does not require intermediate feature engineering, has been recommended to overcome this challenge but end-to-end deep learning models require large labelled training data sets often unavailable in many medical applications. In this study, we trained self-supervised learning (SSL) models for automatic feature extraction from raw photoplethysmography (PPG) obtained using a pulse oximeter, with the aim of predicting paediatric hospitalization. Methods: We compared logistic regression models fitted using features extracted using SSL with models trained using both clinical and SSL features. In addition, we compared end-to-end deep learning models initialized randomly or using weights from the SSL models. We also compared the performance of SSL models trained on labelled data alone (n=1,031) with SSL trained using both labelled and unlabelled signals (n=7,578). Results: Logistic regression models were more predictive of hospitalization when trained on features extracted using labelled PPG signals only compared to SSL models trained on both labelled and unlabelled signals (AUC 0.83 vs 0.80). However, features extracted using SSL model trained on both labelled and unlabelled PPG signals were more predictive of hospitalization when concatenated with clinical features (AUC 0.89 vs 0.87). The end-to-end deep learning model had an AUC of 0.80 when initialized using the SSL model trained on all PPG signals, 0.77 when initialized using SSL trained on labelled data only, and 0.73 when initialized randomly. Conclusions: This study shows that SSL can extract features from PPG signals that are predictive of hospitalization or initialize end-to-end deep learning models. Furthermore, SSL can leverage larger unlabelled data sets to improve performance of models fitted using small labelled data sets.