<p>STREAM clinical workflow.</p>

(1) Patient Data Input: laboratory values (Labs), vital signs (Vitals) are collected and processed at each time window (8h, 24h, 48h, etc.). (2) State Assignment: each patient snapshot is assigned to one of five population states (S1-S5) using Mahalanobis distance (MD) to state centroids; the state with minimum MD is selected (example shows S2 selected with MD = 1.8).

(3) State Movement and Feature Importance: At each snapshot, the patient's state assignment (example: S4 → S1 → S2 → S5) and feature importance (e.g., GCS, lactate, creatinine at 48hrs) are determined. (4) Downstream Applications: STREAM outputs support three clinical functions: risk alerts based on state outlier detection, mortality prediction via XGBoost models using 34 features, and interpretability through feature importance analysis.