Detecting Algorithmic Bias in ICU Clinical Decision: A Doubly-Robust Framework for Auditing Treatment Recommendation Disparities

Clinical decision support systems increasingly guide ICU care, but may perpetu-ate or amplify existing healthcare disparities. We develop a doubly-robust statistical framework for detecting and quantifying algorithmic bias in ICU treatment recommen-dations. Rather than prescribing treatment allocation, our approach audits existing clinical decision support systems to identify disparities in predicted treatment benefits across demographic groups. Analyzing 193,683 patients from the eICU database, we demonstrate the framework’s ability to detect systematic biases. For age-based anal-ysis, we identify a 5.1 percentage point mortality disparity with differential predicted treatment effects (3.2pp younger vs. 1.8pp older patients). For race-based analysis, severity-adjusted outcome disparities (average 2.2pp, reaching 5.6pp at high severity) suggest potential differences in care quality or algorithmic recommendations despite similar aggregate outcomes. We quantify how different fairness metrics (demographic parity, equalized odds, calibration) reveal distinct bias patterns, providing guidance for bias auditing in clinical AI systems. This framework enables healthcare systems to identify and address algorithmic bias before deployment, supporting more equitable clinical decision support.