Causal dynamic feature importance: a novel AI architecture for real-time critical illness triage in emergency departments

Ibtihaj Abdulmohsen Almutairi; Shahad Saud Al Jabr; Raghad Abdullah AlGhamdi; Basil Mohammed Almaghrabi; Warif Hani Farrash; Ehdaa Ali Alabbad; Abdulrahman Nabeel J. Qutub; Baraah Saad Alsaedi; Anas Reda Kurdi; Sara Hamed Abosabaah; Ayman Mohammed Kharaba

doi:10.24911/IJMDC.51-1765693709

2026, Vol: 10, Issue: 1

10 / 1Current Issue Online First Archive Aims and Scope Abstracting & Indexing Most Accessed Articles Most Downloaded Articles Most Cited Articles

« Previous Article

Original Article
Online Published: 20 Jan 2026

IJMDC. 2026; 10(1): 163-171

doi: 10.24911/IJMDC.51-1765693709

Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments

Ibtihaj Abdulmohsen Almutairi, Shahad Saud Al Jabr, Raghad Abdullah Alghamdi, Basil Mohammed Almaghrabi, Warif Hani Farrash, Ehdaa Ali Alabbad, Abdulrahman Nabeel J. Qutub, Baraah Saad Alsaedi, Anas Reda Kurdi, Sara Hamed Abosabaah, Ayman Mohammed Kharaba.

Abstract
Objective: This framework aimed to combine real-time flexibility with causal reasoning, leading to more reliable, explainable, and clinically compatible AI-informed decisions in the emergency environment.
Methods: The causal dynamic feature importance on triage (CDFI-Triage) framework was designed to support real-time clinical decision-making by continuously adjusting the importance of physiological features based on evolving causal relationships with the onset of critical illness. A time-evolving causal graphs, updates causal strengths were conducted using an adaptive Kalman filter and approximates interventional probabilities with a neural causal estimator employing counterfactual dropout. The system integrated causal features with non-causal contextual data through a modified Temporal Fusion Transformer, producing both predictions and interpretable explanations of the evolving physiological drivers of risk.
Result: Baseline models performed worse than the CDFI-Triage in predictive performance (maximum AUC = 0.80) using the MIMIC-III database (CDFI-Triage 1-6-hour horizons (AUC = 0.89, 0.87, 0.85, 0.83)). The highest physiological plausibility (Causal Consistency Score = 0.86 + ± 0.03, p < 0.01) and adaptation to both acute and gradual physiological changes (mean update time = 8.2-15.7 min) were also obtained with the framework.
Conclusion: The CDFI-Triage framework integrated dynamic causal reasoning with real-time monitoring, improving prediction accuracy and interpretability. It adapted feature importance according to evolving patient states, distinguishing proper physiological drivers from noise. The system provided transparent and actionable insights for clinicians in real-time triage.

Key words: AI, causal dynamic feature importance, emergency department, triage.

	ARTICLE TOOLS
	Abstract
	PDF Fulltext
	How to cite this article
	Citation Tools
	Related Records
	Articles by Ibtihaj Abdulmohsen Almutairi Articles by Shahad Saud Al Jabr Articles by Raghad Abdullah AlGhamdi Articles by Basil Mohammed Almaghrabi Articles by Warif Hani Farrash Articles by Ehdaa Ali Alabbad Articles by Abdulrahman Nabeel J. Qutub Articles by Baraah Saad Alsaedi Articles by Anas Reda Kurdi Articles by Sara Hamed Abosabaah Articles by Ayman Mohammed Kharaba
	on Google
	on Google Scholar

How to Cite this Article

Pubmed Style

Almutairi IA, Jabr SSA, Alghamdi RA, Almaghrabi BM, Farrash WH, Alabbad EA, Qutub ANJ, Alsaedi BS, Kurdi AR, Abosabaah SH, Kharaba AM. Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. IJMDC. 2026; 10(1): 163-171. doi:10.24911/IJMDC.51-1765693709

Web Style

Almutairi IA, Jabr SSA, Alghamdi RA, Almaghrabi BM, Farrash WH, Alabbad EA, Qutub ANJ, Alsaedi BS, Kurdi AR, Abosabaah SH, Kharaba AM. Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. https://www.ijmdc.com/?mno=303151 [Access: January 25, 2026]. doi:10.24911/IJMDC.51-1765693709

AMA (American Medical Association) Style

Almutairi IA, Jabr SSA, Alghamdi RA, Almaghrabi BM, Farrash WH, Alabbad EA, Qutub ANJ, Alsaedi BS, Kurdi AR, Abosabaah SH, Kharaba AM. Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. IJMDC. 2026; 10(1): 163-171. doi:10.24911/IJMDC.51-1765693709

Vancouver/ICMJE Style

Almutairi IA, Jabr SSA, Alghamdi RA, Almaghrabi BM, Farrash WH, Alabbad EA, Qutub ANJ, Alsaedi BS, Kurdi AR, Abosabaah SH, Kharaba AM. Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. IJMDC. (2026), [cited January 25, 2026]; 10(1): 163-171. doi:10.24911/IJMDC.51-1765693709

Harvard Style

Almutairi, I. A., Jabr, . S. S. A., Alghamdi, . R. A., Almaghrabi, . B. M., Farrash, . W. H., Alabbad, . E. A., Qutub, . A. N. J., Alsaedi, . B. S., Kurdi, . A. R., Abosabaah, . S. H. & Kharaba, . A. M. (2026) Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. IJMDC, 10 (1), 163-171. doi:10.24911/IJMDC.51-1765693709

Turabian Style

Almutairi, Ibtihaj Abdulmohsen, Shahad Saud Al Jabr, Raghad Abdullah Alghamdi, Basil Mohammed Almaghrabi, Warif Hani Farrash, Ehdaa Ali Alabbad, Abdulrahman Nabeel J. Qutub, Baraah Saad Alsaedi, Anas Reda Kurdi, Sara Hamed Abosabaah, and Ayman Mohammed Kharaba. 2026. Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. International Journal of Medicine in Developing Countries, 10 (1), 163-171. doi:10.24911/IJMDC.51-1765693709

Chicago Style

Almutairi, Ibtihaj Abdulmohsen, Shahad Saud Al Jabr, Raghad Abdullah Alghamdi, Basil Mohammed Almaghrabi, Warif Hani Farrash, Ehdaa Ali Alabbad, Abdulrahman Nabeel J. Qutub, Baraah Saad Alsaedi, Anas Reda Kurdi, Sara Hamed Abosabaah, and Ayman Mohammed Kharaba. "Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments." International Journal of Medicine in Developing Countries 10 (2026), 163-171. doi:10.24911/IJMDC.51-1765693709

MLA (The Modern Language Association) Style

Almutairi, Ibtihaj Abdulmohsen, Shahad Saud Al Jabr, Raghad Abdullah Alghamdi, Basil Mohammed Almaghrabi, Warif Hani Farrash, Ehdaa Ali Alabbad, Abdulrahman Nabeel J. Qutub, Baraah Saad Alsaedi, Anas Reda Kurdi, Sara Hamed Abosabaah, and Ayman Mohammed Kharaba. "Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments." International Journal of Medicine in Developing Countries 10.1 (2026), 163-171. Print. doi:10.24911/IJMDC.51-1765693709

APA (American Psychological Association) Style

Almutairi, I. A., Jabr, . S. S. A., Alghamdi, . R. A., Almaghrabi, . B. M., Farrash, . W. H., Alabbad, . E. A., Qutub, . A. N. J., Alsaedi, . B. S., Kurdi, . A. R., Abosabaah, . S. H. & Kharaba, . A. M. (2026) Causal dynamic feature importance: A novel AI architecture for real-time critical illness triage in emergency departments. International Journal of Medicine in Developing Countries, 10 (1), 163-171. doi:10.24911/IJMDC.51-1765693709

Most Viewed Articles

Most Accessed Articles

Marginal adaptation of fixed prosthodontics
Shahad Mohammed Halawani, Sahar Amer Al-Harbi
IJMDC. 2017; 1(2): 78-84
» Abstract » doi: 10.24911/IJMDC.1.2.7

Parasites in central nervous system
Amal Ahmed Mohamed, Asmaa Mohamed Mansour
IJMDC. 2017; 1(2): 72-77
» Abstract » doi: 10.24911/IJMDC.1.2.6

Non-diabetic retinopathy: a case report
Hassan F. Alkwikbi, Nabil Mamon Abdelfattah, Haithem Mamon Abdelfattah
IJMDC. 2017; 1(1): 33-37
» Abstract » doi: 10.24911/IJMDC.1.1.6

Vitamin D deficiency among high school female students in Riyadh
Sahar Mohsen Aldhafeeri, Fatemah Ibraheem Alrawaji, Abrar Mubarak Algharbi, Alanoud Abdullah Alhessan, Ayat Sami Qabaja, Ghaleah Abdulaziz Alnassar, Ghaliah Ofayn Alsulami, Mashael Belal Alrubaian, Norah Abdulaziz Alhatim, Salehah Salih Alotaibi, Zahra Ali Alkhamees
IJMDC. 2017; 1(1): 18-23
» Abstract » doi: 10.24911/IJMDC.1.1.4

Prognosis of chronic complications of diabetes mellitus (DM) after multiple events of diabetic ketoacidosis (DKA)
Baraa Faiez Rajab, Anwar Essa Alamrim, Ali Essa Alamri
IJMDC. 2019; 3(5): 474-479
» Abstract » doi: 10.24911/IJMDC.51-1546551993

Most Downloaded

Top Downloaded Articles

Perception and attitude of medical students towards trauma and orthopedic teaching: a cross-sectional study
Nawaf Hameed Almohammadi, Faisal Ali Almesned, Atif Omar Alhawsah, Sami Aoudah Alahmari, Madloul Jassim Alshammari, Hamad Ali Alkhunayfir
IJMDC. 2019; 3(6): 503-508
» Abstract » doi: 10.24911/IJMDC.51-1548706801

Anti-IL-17 markedly inhibited the in vitro granuloma induced by Schistosoma mansoni soluble egg antigen.
Asmaa Ezz, Irene S. Gmail, Fatma Elzahraa H. Salem, Rabab Salama, Soad Nady
IJMDC. 2018; 2(January 2018): 38-46
» Abstract » doi: 10.24911/IJMDC.2.1.7

Antibiotic Resistance Crisis
Nuha Saad Mobarki, Buthaina Abdullah Almerabi, Ahmad Hattan Hattan
IJMDC. 2019; 3(6): 561-564
» Abstract » doi: 10.24911/IJMDC.51-1549060699

Marginal adaptation of fixed prosthodontics
Shahad Mohammed Halawani, Sahar Amer Al-Harbi
IJMDC. 2017; 1(2): 78-84
» Abstract » doi: 10.24911/IJMDC.1.2.7

Most Cited Articles

Most Cited Articles

Antibiotic Resistance Crisis
Nuha Saad Mobarki, Buthaina Abdullah Almerabi, Ahmad Hattan Hattan
IJMDC. 2019; 3(6): 561-564
» Abstract » doi: 10.24911/IJMDC.51-1549060699
Cited : 34 times [Click to see citing articles]

Prevalence of depression, anxiety and stress among diabetes mellitus patients in Arar, Northern Saudi Arabia
AMohammed Elamin Mukrim, Nujud Muteb D. Alshammari, Wurud Muteb D. Alshammari, Maali Subhi T. Alshammari, Yousef Nasif R. Alshammari, Abdulaziz Sael M. Alshammari, Maisa Hamad F. Alanazi, Abdulelah Abdulrhman F. Alzammam, Muharib Mana M. Alshammari, Slwa Khaled Abu Asyah, Aseel Jamal Alzuhayri, Mushref Saeid Alshammari
IJMDC. 2019; 3(3): 229-233
» Abstract » doi: 10.24911/IJMDC.51-1542576396
Cited : 8 times [Click to see citing articles]

Knowledge, attitude, and practice of breast self-examination toward breast cancer among female students at King Saud University in Riyadh, Saudi Arabia
Abdullah Nasser Alomair, Dania Ghazi Felemban, Mohannad Sami Felemban, Jameel Abdullah Awadain, Ammar Saud Altowairqi, Nawaf Fawzan Alfawzan, Fatimah Mohammed Almazayen, Abdulrahman Jalwi Korkoman, Nawaf Saad Alrusayyis
IJMDC. 2020; 4(2): 429-434
» Abstract » doi: 10.24911/IJMDC.51-1576668182
Cited : 8 times [Click to see citing articles]

Population awareness about rheumatoid arthritis in Jazan region, Saudi Arabia
Ahmad Ali Hazzazi, Mohssen Hassen Ageeli, Ahmed Ali Muyidi, Abdulaziz Mohammad Abulgasim, Abdullah Ahmad Yateemi, Nabil Alhakami
IJMDC. 2020; 4(3): 668-675
» Abstract » doi: 10.24911/IJMDC.51-1576010943
Cited : 4 times [Click to see citing articles]

Prevalence and factors associated with depression among health care workers in National Guard Hospital in Riyadh, KSA
Noor Mohammad AlFahhad
IJMDC. 2018; 2(September 2018): 92-96
» Abstract » doi: 10.24911/IJMDC.51-1526306040
Cited : 4 times [Click to see citing articles]

Effect of inter-pregnancy interval on pregnancy outcome: a prospective study at Fayoum, Egypt
Eman M. Mahfouz, Naglaa A. El-Sherbiny, Wafaa Y. Abdel Wahed, Nashwa S. Hamed
IJMDC. 2018; 2(May 2018): 38-44
» Abstract » doi: 10.24911/IJMDC.51-1520268317
Cited : 4 times [Click to see citing articles]

Diabetic neuropathy in Saudi Arabia: a comprehensive review for further actions
Mohammad Mater Aljohani, Amjad Taj Karam, Ayman Abdulaziz Alamri, Mohammed Hamed Manfaloti, Hussain Abbas Alnakhli, Hatem Ahmed Shaqroon
IJMDC. 2020; 4(11): 2008-2013
» Abstract » doi: 10.24911/IJMDC.51-1601343665
Cited : 4 times [Click to see citing articles]

Public Awareness of coronary artery disease risk factors in Qassim, Saudi Arabia: a cross-sectional study
Abdullah Muzil Albadrani, Saleh Sulaiman Al-Ajlan, Abdullah Saer E. Alharbi, Abdulelah Saud Alharbi, Saif Mohammed Radhi Alharbi
IJMDC. 2020; 4(3): 593-599
» Abstract » doi: 10.24911/IJMDC.51-1572217065
Cited : 4 times [Click to see citing articles]

Ischemic stroke: prevalence of modifiable risk factors in the Saudi population
Muhannad Noor Alharbi, Atheer Khalid Alharbi, Mousa Atqan Alamri, Abdulmalik Ayedh Saad Alharthi, Abdulrahman Moneer Alqerafi, Mohamed Noor Alharbi
IJMDC. 2019; 3(7): 601-603
» Abstract » doi: 10.24911/IJMDC.51-1548376707
Cited : 3 times [Click to see citing articles]

Prevalence and risk factors for diabetic nephropathy in type 2 diabetic patients, Taif City, Saudi Arabia
Basel Saad Alzahrani, Turki Hamdan Alzidani, Abdullah Mohammed Alturkistani, Hani Abozaid
IJMDC. 2019; 3(2): 167-172
» Abstract » doi: 10.24911/IJMDC.51-1541336905
Cited : 3 times [Click to see citing articles]

Assessment of knowledge and awareness regarding thyroid disorders among Saudi people
Assem Saleh Ali Almuzaini , Bayan ahmad I Alshareef , Sundos Hamoud O Alghamdi, Ayman Adnan Munshy, Abdulmajeed Khalid M. Aljarallah, Saud Abdulaziz A Salman, Khalid Saud Alroqi, Reem Dayel A Alkhaldi
IJMDC. 2019; 3(12): 1070-1076
» Abstract » doi: 10.24911/IJMDC.51-1568037206
Cited : 3 times [Click to see citing articles]

Assessment of knowledge, attitude, and practice in relation to use of isotretinoin among Al-Madinah population, Saudi Arabia
Amr Molla, Hassan Abdullah Alrizqi, Emtinan Mohammed Salem Alruhaili, Saad Abdullah Alrizqi, Arwa Musaad Alsubhi
IJMDC. 2020; 4(1): 107-112
» Abstract » doi: 10.24911/IJMDC.51-1571752077
Cited : 3 times [Click to see citing articles]

Ethical considerations in doctors & pharmaceutical industries relationship: a narrative review
Mohammed Saud Almasri, Yousef Rafat Bukhari, Bandar Saleh Alzuair, Mansour Khalid Almadi, Amro Khalid Bin Abdulrahman
IJMDC. 2020; 4(1): 244-252
» Abstract » doi: 10.24911/IJMDC.51-1572794591
Cited : 3 times [Click to see citing articles]

Assessment of the knowledge of pregnant women regarding the effects of GDM on mothers and neonates at a Maternal and Children hospital in Najran, Saudi Arabia
Amina Abdo Salhi, Medical Intern, Majed Saeed Alshahrani, Maram Mohammed Alyamin, Waad Ahmed Hamdi, Sarah Raja Alyami, Albatool Saleh Almagbool, Nujoud Hamad Almoqati, Seham Hamad Almoqati, Esra'a Amer Nasser Al-Saaed, Hessa Salem Al Habes, Batool Mubarak Abdullah Alwdei, Ahlam Yhya Saeed Alyami, Wesal Ahmed Alassiri
IJMDC. 2019; 3(4): 370-375
» Abstract » doi: 10.24911/IJMDC.51-1545817090
Cited : 3 times [Click to see citing articles]

Awareness of the Saudi population about the role of the Emergency Rooms
Zead Ibrahim A. Alhussain, Mohammed Ali A. Alghamdi, Rana Mohamed Ahmed, Abdullah Yahya Aldhban, Abdulrahman Ali Alghamdi, Naif Shalan J. Alalyani
IJMDC. 2019; 3(11): 957-962
» Abstract » doi: 10.24911/IJMDC.51-1568717752
Cited : 3 times [Click to see citing articles]

About International Journal of Medicine in Developing Countries

Contact Information

How to cite this article