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Enhancing Delirium Case Definitions in Electronic Health Records Using Clinical Free Text

机译：使用临床自由文本增强电子健康记录中的谵妄案例定义

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Background: Delirium is an acute confusional state, associated with morbidity and mortality in diverse medically ill populations. Delirium is preventable and treatable when diagnosed but the diagnosis is often missed. This important and difficult diagnosis is an attractive candidate for computer-aided decision support if it can be reliably identified at scale. Objective: Here, using an electronic health record based case definition of delirium, we characterize incidence of this highly morbid condition in 2 large academic medical centers. Methods: Using the electronic health record of 2 large New England academic medical centers, we calculated and compared the rate of the diagnosis of delirium using a range of administrative and discharge summary text-based case definitions over an 8-year period. Results: Depending on case definitions, the overall delirium rate ranged from 2.0-5.4% of 809,512 admissions identified. The idented rate of delirium increased between 2005 and 2013, such that by the final year of the study, one of the two sites reported delirium in 7.0% of cases. The concordance between case definitions was low; only half of the cases identified by text analysis were captured by administrative data. Conclusion: Delirium may be better captured by composite outcomes, including both administrative claims data and elements drawn from unstructured data sources. That the rate of delirium observed in this study is far lower than the current literature estimates suggests that further work on case definitions, identification, and documented diagnosis is required.
机译：背景：谵妄是一种急性精神错乱状态，与多种疾病人群的发病率和死亡率有关。谵妄在诊断时是可以预防和治疗的，但往往会错过诊断。这种重要而困难的诊断，如果能够在规模上可靠地识别，将是计算机辅助决策支持的一个有吸引力的候选。目的：在这里，我们使用基于电子健康记录的谵妄病例定义，描述了两个大型学术医疗中心这种高度病态状态的发病率。方法：使用两个新英格兰大型学术医疗中心的电子健康记录，我们使用一系列基于行政和出院总结文本的病例定义，计算并比较了8年期间谵妄的诊断率。结果：根据病例定义，在已确认的809512例入院患者中，总体谵妄率在2.0-5.4%之间。2005年至2013年间，谵妄的识别率有所上升，因此到研究的最后一年，这两个地点中的一个报告了7.0%的谵妄病例。病例定义之间的一致性较低；通过文本分析确定的案例中，只有一半被行政数据捕获。结论：综合结果可能更好地捕捉谵妄，包括行政索赔数据和来自非结构化数据源的元素。这项研究中观察到的谵妄发生率远低于目前的文献估计，这表明需要在病例定义、识别和记录诊断方面进行进一步的工作。

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